Yesterday, Today and Tomorrow · 2019-12-16 · Understanding the Invisible Scars of Ebola: Mental...
108
NIH Fogarty International Center Pathways to Global Health Research Careers: Yesterday, Today and Tomorrow Presentations by: Gilberte Bastien Understanding the Invisible Scars of Ebola: Mental Health and Resiliency in Liberia Ramnath Subbaraman Navigating a career through the world’s largest tuberculosis epidemic Hendry Sawe Building local research capacity to impact care of acutely ill sickle cell individuals in LIC: Experience from Tanzania Lisa Bebell Postpartum Infections in Uganda Mario Cornejo-Olivas Lessons from Neurogenetics Research in a developing country Carla Chibwesha Leveraging FICRF training to improve cervical cancer prevention in Southern Africa Jeffery Blander Catalyzing Innovation for Global Health March, 2018
Yesterday, Today and Tomorrow · 2019-12-16 · Understanding the Invisible Scars of Ebola: Mental Health and Resiliency in Liberia. Gilberte (“Gigi”) Bastien, PhD. Instructor
NIH Fogarty International Center Pathways to Global Health Research Careers
Yesterday Today and TomorrowPresentations by
Gilberte Bastien Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Ramnath Subbaraman Navigating a career through the worldrsquos largest tuberculosis epidemic
Hendry Sawe Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Lisa Bebell Postpartum Infections in Uganda
Mario Cornejo-Olivas Lessons from Neurogenetics Research in a developing country
Carla Chibwesha Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Jeffery Blander Catalyzing Innovation for Global Health
March 2018
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Gilberte (ldquoGigirdquo) Bastien PhDInstructor ndash Department of Psychiatry amp Behavioral Sciences
Assistant Director for the Office of Global HealthMorehouse School of Medicine
March 2018
Personal BackgroundAcademic Training BS ndash Xavier University of Louisiana MS amp PhD ndash University of Mississippi Postdoctoral training ndash VA San Diego Healthcare System amp
Morehouse School of Medicine
Fogarty Fellowship Site Liberia ndash The Carter Center Mental Health Program
Fogarty-Funded Research Project
ldquoResilience in the Face of Tragedy Examining Psychosocial Health and Resiliency in Individuals amp Communities Recovering from Ebola in Liberiardquo
Primary Mentors
Janice Cooper PhD David Wohl MD and William Fischer MD
Background
Ebola Virus Disease (EVD) Epidemic
West African EVD epidemic 2014 ndash 2016
Liberia Guinea Sierra Leone
Most widespread EVD outbreak in history
28000 infected (~11000 Liberians)
Background
What are EVDrsquos MentalPsychosocial Impacts
Psychiatric symptoms amp EVD stigmaTriggers of unresolved trauma from past civil warsLoss of family friends and co-workersCompromised spiritual and religious ritualspractices due to
health and safety protocols
Cultural mores and community traditions abated (death and burials)
Specific Aims
Aim 1 Assess prevalence of mental health and psychosocial problems across target groups
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Gilberte (ldquoGigirdquo) Bastien PhDInstructor ndash Department of Psychiatry amp Behavioral Sciences
Assistant Director for the Office of Global HealthMorehouse School of Medicine
March 2018
Personal BackgroundAcademic Training BS ndash Xavier University of Louisiana MS amp PhD ndash University of Mississippi Postdoctoral training ndash VA San Diego Healthcare System amp
Morehouse School of Medicine
Fogarty Fellowship Site Liberia ndash The Carter Center Mental Health Program
Fogarty-Funded Research Project
ldquoResilience in the Face of Tragedy Examining Psychosocial Health and Resiliency in Individuals amp Communities Recovering from Ebola in Liberiardquo
Primary Mentors
Janice Cooper PhD David Wohl MD and William Fischer MD
Background
Ebola Virus Disease (EVD) Epidemic
West African EVD epidemic 2014 ndash 2016
Liberia Guinea Sierra Leone
Most widespread EVD outbreak in history
28000 infected (~11000 Liberians)
Background
What are EVDrsquos MentalPsychosocial Impacts
Psychiatric symptoms amp EVD stigmaTriggers of unresolved trauma from past civil warsLoss of family friends and co-workersCompromised spiritual and religious ritualspractices due to
health and safety protocols
Cultural mores and community traditions abated (death and burials)
Specific Aims
Aim 1 Assess prevalence of mental health and psychosocial problems across target groups
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Personal BackgroundAcademic Training BS ndash Xavier University of Louisiana MS amp PhD ndash University of Mississippi Postdoctoral training ndash VA San Diego Healthcare System amp
Morehouse School of Medicine
Fogarty Fellowship Site Liberia ndash The Carter Center Mental Health Program
Fogarty-Funded Research Project
ldquoResilience in the Face of Tragedy Examining Psychosocial Health and Resiliency in Individuals amp Communities Recovering from Ebola in Liberiardquo
Primary Mentors
Janice Cooper PhD David Wohl MD and William Fischer MD
Background
Ebola Virus Disease (EVD) Epidemic
West African EVD epidemic 2014 ndash 2016
Liberia Guinea Sierra Leone
Most widespread EVD outbreak in history
28000 infected (~11000 Liberians)
Background
What are EVDrsquos MentalPsychosocial Impacts
Psychiatric symptoms amp EVD stigmaTriggers of unresolved trauma from past civil warsLoss of family friends and co-workersCompromised spiritual and religious ritualspractices due to
health and safety protocols
Cultural mores and community traditions abated (death and burials)
Specific Aims
Aim 1 Assess prevalence of mental health and psychosocial problems across target groups
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Background
Ebola Virus Disease (EVD) Epidemic
West African EVD epidemic 2014 ndash 2016
Liberia Guinea Sierra Leone
Most widespread EVD outbreak in history
28000 infected (~11000 Liberians)
Background
What are EVDrsquos MentalPsychosocial Impacts
Psychiatric symptoms amp EVD stigmaTriggers of unresolved trauma from past civil warsLoss of family friends and co-workersCompromised spiritual and religious ritualspractices due to
health and safety protocols
Cultural mores and community traditions abated (death and burials)
Specific Aims
Aim 1 Assess prevalence of mental health and psychosocial problems across target groups
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Background
What are EVDrsquos MentalPsychosocial Impacts
Psychiatric symptoms amp EVD stigmaTriggers of unresolved trauma from past civil warsLoss of family friends and co-workersCompromised spiritual and religious ritualspractices due to
health and safety protocols
Cultural mores and community traditions abated (death and burials)
Specific Aims
Aim 1 Assess prevalence of mental health and psychosocial problems across target groups
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
High levels of reported stigma Highest among religiousspiritual leaders amp health
workers)
Significant group differences in endorsed sense of resilience
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
EVD Survivors
77
61
38
0
10
20
30
40
50
60
70
80
90
Sub Use Depression PTSD
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Preliminary Results
Overarching Qualitative Themes
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Lessons Learned amp Advice
Mental health is critical in large-scale emergencies
Disasters can uncover pre-existing needs and catalyze change
Increased political will commitment and resources Immediate response but with an eye to sustainability amp
capacity buildingenhancing
Valuing of existing resources strengths and cultural modes of healing (individual and community levels)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Next Steps
Faculty Appointment ndash Department of Psychiatry amp Behavioral Sciences (Morehouse School of Medicine)
Assistant Director ndash Office of Global Health (MSM)
Application of learnings to other settings
Recent K01 submission to the FIC Haiti-based disaster mental health project
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Acknowledgements
NIH Fogarty International Center
UJMT Fogarty Global Health Fellowship
The Carter Center Mental Health Program Liberia
Research Team Worpoe Woahloe Riches Jippy Hawa Kiazolu Lawrence Dolo Sam Sumo Sehwah Sonkarlay
Morehouse School of Medicine
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Contact Information
Gilberte (ldquoGigirdquo) Bastien PhD
Office of Global Health
Morehouse School of Medicine
gbastienmsmedu
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Navigating a career through the worldrsquos largest tuberculosis epidemic
Ramnath Subbaraman MD MScAssistant Professor
Department of Public Health and Community MedicineTufts University School of Medicine
(supported by the Global Health Equity Scholars Consortium)
INDIAN COUNCIL OF MEDICAL RESEARCH
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
17
Academic Training Yale University School of Medicine (medical school)
UCSF (internal medicine residency)
Brigham and WomenrsquosMassachusetts General Hospital (infectious diseases fellowship)
Fogarty Fellowship Site National Institute for Research in Tuberculosis (NIRT Chennai India)
Fogarty-Funded Research ProjectldquoInvestigating pretreatment loss to follow-up of tuberculosis patients in Chennai Indiardquo
Primary MentorsKenneth Mayer (Harvard)Lee Riley (UC Berkeley)Beena Thomas and Soumya Swaminathan (NIRT)
Personal background
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Mentors and Collaborators
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
19
India accounts for one-quarter of TB cases one-third of TB deaths and one-third of ldquomissingrdquo TB patients globally
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
20
The Cascade of Care Model
Helps to visualize ldquogapsrdquo in care delivery
Guides UNAIDSrsquo ldquo90-90-90rdquo global HIV targets
Not previously used for TB before this analysis
Our aim was to estimate the TB care cascade for India
We also conducted tracked TB patients in Chennai (4th largest city) to understand a key gap in the care cascade
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
21
Methods National Care Cascade
TB prevalence and MDR TB burden extracted from the 2015 WHO Global TB Report
Notification and treatment completion data extracted from Indian government official reports
Other indicators estimated by systematic reviews + meta-analyses of Indian studies from 2000-2015
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
22
Cascade for all forms of TB in India 2013
762000 (28) never seek government TB care 520000 (20) seek
government care but are never started on treatment
310000 (11) seek government care but are not diagnosed212000 (8) are diagnosed but
never registered in treatment
Subbaraman R et al PLOS Medicine 201613(10)e1002149
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
23
Multidrug-resistant TB cascade 2013
36000 (59) MDR patients are evaluated at government TB centers but are undiagnosed or misdiagnosed
Subbaraman R et al PLOS Medicine 201613(10)e1002149
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
24
Main findings Overall Cascade
About 39 of all prevalent TB patients in India achieved one-year recurrence free survival
500000 TB patients reach government TB services but are not diagnosed or started on treatment
Pretreatment loss to follow-up is a bigger gap than loss to follow-up while on TB treatment
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
25
Methods Pretreatment loss to follow-up in Chennai
Tracked patients from 22 microscopy centers that diagnose 90 of TB patients in govt sector
Audited microscopy center registers to find out
Where TB patients are coming from18
Quality of address and phone number information17
Defined pretreatment loss to follow-up as
Not starting TB therapy within 14 days
Starting therapy but never officially registered by the national TB program
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
26
Where are Chennairsquos TB patients coming from
17 of smear-positive TB patients diagnosed had addresses out of Chennai
53 screened at the largest tertiary center had addresses outside of Chennai
Patients with addresses in Chennai highly clustered within a few city pincodes
Subbaraman R et al PLOS One 201712(8)e0183240
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
27Subbaraman R et al PLOS One 201712(8)e0183240
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
28
Pretreatment Loss to Follow-Up Findings
22 of patients diagnosed in Chennairsquos TB program were lost to follow-up prior to starting treatment or getting registered
Of these ldquolostrdquo patients 37 were found alive by study team
36 were untrackable
28 had died
Thomas B Subbaraman R et al BMC Infectious Diseases 2018 (forthcoming)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
29
Cascade for Advocacy Media Coverage
Indiarsquos National Strategic Plan for TB Elimination (2017-2025)
bull Lists ldquoplugging leaks in the TB cascade of carerdquo as a central goalbull Section on ldquomaking cascade monitoring a management priorityrdquobull States ldquocascade care check indicatorsrdquo must be incorporated into
all state government TB reports
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
30
Lessons learned and advice
We often work within weak health systems in LMICsmdashdonrsquot ignore that issue engage it
Translating concepts from one disease (HIV) to another disease (TB) can yield new insights
Considerable benefits to conducting research on an issue at different scales (ie local and national levels)
Keep pushing forward on an issue if you personally think it is important and relevant
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
31
Post-Fogarty Outcomes
Collaborative grant from the Bill amp Melinda Gates Foundation to study TB digital adherence monitoring technologies
Institutional ldquoKrdquo award and Harvard Center for AIDS Research grant for ongoing TB implementation science research
As of January 1 transitioned to a new faculty position at Tufts
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience
from Tanzania
Dr Hendry R SaweEmergency Physician Head Emergency MedicineMuhimbili University of Health and Allied SciencesDar es salaam TanzaniaGloCal Fellow 2014-2015
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Financial Disclosure
This project was supported by a National Institutes of Health Research TrainingGrant funded by the Fogarty International Center and the National Heart Lungand Blood Institute as well as the University of California Global Health Institute
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
FACTS AND FIGURESbullPopulation= 50 MillionbullFM Ratio=11bullLife expectancy = 52 yearsbullMaternal mortality= 454bullHIV prevalence= 52bullLeading cause of death (all age)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Personal BackgroundAcademic Training Doctor of Medicine (MD) MUHAS Tanzania Masters of Medicine (MMED) MUHAS Tanzania Master of Business Administration (MBA) Mzumbe University Tanzania PhD in Emergency Medicine (ongoing) University of Cape Town South
Africa
GloCal Health Fellowship Fellowship Site Muhimbili University of Health and Allied Sciences (MUHAS) Tanzania
Fogarty-Funded Research Project ldquoClinical epidemiology of patients with chronic disease presenting to an urban emergency department in Tanzania Experience from Sickle Cell Disease or HIVrdquo
Primary Mentors Dr Teri Reynolds (UCSF) Prof Julie Makani (MUHAS) Prof Lee Alan Wallis (University of Cape Town)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Background
Sickle cell disease (SCD) is prevalent in sub-Saharan Africa with high risk of complications requiring emergency care
More than half of children born with SCD in Sub-Saharan Africa die before adulthood
Tanzania ranks fourth globally in birth incidence of SCD
We aimed to describe the clinical presentation resource utilization and outcomes of SCD patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Specific Aims
To describe the patients screened and treated for SCD in the ED of MNH
To describe the management strategies of patients with SCD presenting to ED of MNH
To determine the in-hospital mortality of patients with SCD presenting to ED of MNH
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Study setting - Muhimbili National Hospital
bull Public National Referral Hospital Largest in Tanzania
bull First dedicated ED in the Country opened in 2010
bull ED acuity is high 70 admission rate
bull MNH Sickle cell treatment and research centre
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Lessons Learned and Advice
Dissemination of results expected to help identify patients with SCD and for those with SCD to alert clinicians to related conditions amp sequelae requiring urgent treatment to improve outcomes
Plan to develop strategies to educate clinical staff on treatment guidelines to improve clinical outcomes of persons with SCD
Data help to inform development of clinical research aimed at optimizing care of the SCD patients
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Next Steps
Conducting a RCT of Intranasal Ketamine for pain in SCD patients
Propagating the Emergency Medicine research program at MUHAS
Mentorship for prospective GloCal Fellows
The GloCal steering committee
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Thank you
hsawemuhasactz
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Postpartum Infections in Uganda
Presented by
Lisa Bebell MDInstructor Harvard Medical SchoolAssistant in Medicine Massachusetts General Hospital
March 2018
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectMaternal sepsis in Mbarara Ugandamdashepidemiology microbiology and the effect of a nursing intervention promoting early recognition of sepsis
Primary Mentors
Ben Andrews (Vanderbilt)David Bangsberg (HarvardMGH)Laura Riley (HarvardMGH)Joseph Ngonzi (MUSTUganda)
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Personal BackgroundAcademic Training
Medical School (2002-2008) ndash
Columbia University College of Physicians and Surgeons
Fogarty Fellow lsquo05-rsquo06 CAPRISA South Africa
Doris Duke Fellow lsquo06-rsquo07 UCSF Uganda Residency and Chief Residency (2008-2012) ndash
University of California San Francisco
Infectious Diseases and Critical Care Medicine Fellowships (2012-2014) ndash
Harvard Combined Programs
Fogarty Fellowship Site 2005-2006 CAPRISA DurbanCape Town South Africa 2014-2015 VECD Consortium Uganda
Fogarty-Funded Research ProjectPostpartum Infection and Mbarara Regional Referral Hospital ndash Epidemiology Microbiology and Outcomes
~ AKA ~Uganda Peripartum Infection and Mortality Study (UPIM)
Lesson 1 Be flexibleLesson 2 Choose a good acronym and make a logo
SA 2
005-
2006
Uga
nda
2007
Uga
nda
2015
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
Study Background
bull Postpartum infections are pregnancy-related infections occurring between the onset of rupture of membranes and the 42nd day after delivery
bull Include endometritis (puerperal sepsis) urinary tract infections (UTIs) bloodstream infections and cesarean surgical site infections
bull Puerperal sepsis causes 10 of maternal deaths in Africa
bull Few prospective studies on incidence microbiology and antimicrobial resistance
bull Cesarean delivery is considered the single most important risk factor for postpartum infection
bull Cesarean delivery is common in Mbarara Uganda and becoming more common throughout sSA
Specific Aims
To determine
bull Incidence of postpartum sepsis and morbidity of postpartum sepsis among pregnant women delivering in Mbarara comparing outcomes by HIV status
bull Which clinical epidemiologic factors associated with risk of postpartum sepsis
bull The microbiology of postpartum sepsis including antimicrobial resistance patterns
Methods
We performed
bull A prospective cohort study of 4231 women presenting in labor for delivery or within 6 weeks postpartum for care
bull Temperature measurements starting after delivery
bull Microbiologic evaluation of febrile and hypothermic women (urine and blood cultures structured exam and interview malaria testing)
bull Descriptive analyses and multivariable logistic regression
4231 enrolled (gt99 of those eligible)
4176 (987) had ge 1 temperature measured
Febrile gt38deg or Hypothermic lt36deg CNormothermic
1708 randomly selectedfor additional data collection
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Overview of Researchmdashinclude publications findings
Research Results
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Research Results
Antimicrobial resistance Gram-NEGATIVE pathogens
1
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Infection type
Genus and species
Ampicillin
( n )
Ceftriaxone
( n )
Cefepime ( n )
Gentamycin
( n )
Ciprofloxacin ( n )
ESBL
( n )
URINARY TRACT ( n=22)
Acinetobacter spp ( n=11)
-
-
11 (100)
11 (100)
10 (91)
-
Escherichia coli ( n=6)
6 (100)
4 (67)
4 (67)
4 (67)
3 (50)
4 (67)
Klebsiella pneumoniae ( n=3)
3 (100)
3 (100)
3 (100)
2 (67)
3 (100)
3 (100)
Pseudomonas aeruginosa ( n=1)
-
-
0 (0)
1 (100)
1 (100)
-
Bulkholderia cepacia ( n=1)
-
-
0 (0)
0 (0)
0 (0)
-
BLOODSTREAM ( n=4)
Acinetobacter junii ( n=1)
-
-
1 (100)
1 (100)
1 (100)
-
Salmonella typhi ( n=1)
1 (100)
0 (0)
0 (0)
0 (0)
0 (0)
-
Probable Veillonella spp ( n=1)
-
-
-
-
-
-
Escherichia coli ( n=1)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
1 (100)
Research Results
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Research Results Postpartum infections and complications by HIV status
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Research Results Postpartum infections and complications by HIV status
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Research Results
Manuscript under review (submitted Dec 2016)
Incidence of postpartum infection outcomes and associated risk factors at Mbarara Regional Referral Hospital in Uganda
Joseph Ngonzi12 Lisa M Bebell34 Yarine Fajardo1 Adeline Boatin5 Mark J Siedner34 Ingrid V Bassett3 Yves Jacquemyn2 Jean-Pierre Van geertruyden2 Jerome Kabakyenga6 Blair J Wylie5 David R Bangsberg7 Laura E Riley5
Univariable MultivariableCharacteristic OR (95 CI) P-value OR (95 CI) P-value
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Number of days admitted to hospital 13 (12-14) lt0001 12 (11-13) 0001
Attended antenatal care ge 4 times 07 (04-12) 020 04 (02-09) 002Multiparous 03 (02-05) lt0001 05 (03-10) 006
Formal employment 06 (04-10) 004 07 (04-12) 020
Number of vaginal exams in labor 10 (09-11) 097 09 (08-11) 024
HIV-infected 10 (05-21) 091 14 (06-33) 049
Age 09 (08-09) lt0001 09 (09-10) 008
Number of hours in labor 10 (10-10) 026 10 (10-10) 066
Referred from an outside facility 23 (14-40) 0002 11 (05-24) 075
Logistic regression analysis of factors associated with composite postpartum infection outcome
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Lessons Learned amp Advice
Lesson 1 Be flexible (and adaptable)
Lesson 2 Choose a good acronym and make a logo
Lesson 3 Relationships are more important than careers (donrsquot feel entitled)
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Lessons Learned
Lesson 4 A good team is everything
Lesson 5 Publications take time ndash consider secondary analyses
Lesson 6 diversify your mentorship
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Next Steps
bull Apply for a career development award (K23)
bull Develop additional collaborations
bull Maintain relationships with collaborators and team in Uganda
bull Consider parallelfollow-on studies in other countries
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Acknowledgements
Ben Andrews Doug Heimburger Sten Vermund Donna Ingles
David Bangsberg Mark Siedner Laura Riley Adeline Boatin
Ingrid Bassett Drucilla Roberts Yap Boum Juliet Mwanga
Mbarara Regional Referral Hospital
MUST Department of Obstetrics and Gynecology Study ParticipantsJoseph Ngonzi Jolly Joe Lapat
MUST Department of PaediatricsJulius Kiwanuka Julian Adong
Contactlbebellmghharvardedu
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Lessons from Neurogenetics Research in a developing
countryPresented by
Mario Cornejo-Olivas MDNeurogenetics Research Center Lima PeruNorthern Pacific Global Health Research Fellow 2012-2013
March 16 2018
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Personal BackgroundAcademic Training MD Universidad Nacional de San Agustin Arequipa
Peru Neurology Universidad Nacional Mayor de San Marcos
Peru MS degree Universidad Peruana Cayetano Heredia
Peru
Fogarty Fellowship Site National Institute for Neurological Sciences Peru
Fogarty-Funded Research Project
ldquoTarget Sequencing Analysis of Parkinsons Disease Genes in a Native Amerindian Population from Puno-Perurdquo
Primary Mentors
Pilar Mazzetti MD MBA (INCN)
Ignacio F Mata PhD (UW)
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Interpreting neurogenetics under ldquoglobal perspectiverdquo
MONOGENIC Huntington
COMPLEX Parkinson
Largest hotspot in LA Venezuela Peru
Causal gene (1993)Genetic markersmight be potentialtargets for novel treatments
There are very limited information regarding variability in Amerindian populations
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Neurogenetics and Global Health why
Orphan ldquoneurogenetic disordersrdquo like HD are not a priority for healthcare system and require innovative and efficient strategies to improve healthcare
Better understanding of genetics of PD including different ancestral populations will better integrate neurodegeneration pathways for novel treatments
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
HD in Peru major research contributions
(haplotypes study) suggest an Amerindianorigin of HD in Peruand Lat Am
the cost of HD in Peru amounts yearly to USD 103391 on average
per patient
ldquo HD Chorea came from Korea the countryrdquo ldquoit is genetic but if you avoid certain behaviors you will be betterrdquo ldquo if you get HD do not have childrenrdquo Global burden of HD variations
affected by genetic factors
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Studying PD in mestizo Peruvian population
Working together withAn Amerindian community
Developing local capacities Genetic epidemiology
for LARGE PD
Reporting new PD mutations
Ancestry should be adequatelyanalyzed when proposingpotential PD risk mutations
Developing Genetic variabilitydatabase of PD genes forAmerindian population
From mentee to mentor PD prevalence study
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Lessons Learned amp Advice
HD healthcare could incorporate global health strategies and become a healthcare model for other rare disorders
Using reference genomic information from Amerindian will improve future Genetic association PD studies clarifying ldquotruerdquo status of genetics variants
Good match of mentors-mentee hellip makes the difference Mentoring team including both senior and junior mentors increases
chances for research goal achievements Enjoy your job and share hellip with your team
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Next StepsNEW POSITIONS- Chief of the Neurogenetic Research Center since 2014- Invited professor at San Marcos Cayetano Heredia
University- Board member of Peruvian Society of NeurologyMENTORING- Local mentor for FOGARTIES (Ana Maryenela Elisonhellip)RESEARCH GRANTSFUNDS - Role PI and coordinator (2018-2020) The EuSAge study
European-South American collaborative project to identify and characterize age-related genetic modifiers and biomarkers of neurodegenerative processes in SCA3MJD
OTHER ACTIVITIES - Outreach clinic for Huntington disease in the CantildeeteValley- Developing local capacities in Puno
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Leveraging FICRF training to improve cervical cancer prevention
in Southern AfricaCarla Chibwesha MD MSc
University of North Carolina at Chapel Hill16 March 2018
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Academic BackgroundAcademic Training
bull MD ndash Brown Universitybull MSc ndash London School of Hygiene amp Tropical Medicinebull OBGyn ndash Brown Universitybull Global Health ndash University of Alabama at Birmingham and
University of North Carolina at Chapel Hill
Fogarty Fellowship Sitebull Centre for Infectious Disease Research in Zambia (2010)
Fogarty-Funded Research Projectbull The effect of lsquoearlyrsquo cryotherapy on HPV clearance among
HIV-infected women
Mentorsbull Chi Mwanahamuntu Parham Stringer
Sani Mountain Pass KZN South Africa
Sani Mountain Pass KZN South Africa
Hennops GP South Africa
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
GLOBOCAN 2012
of the burden of cervical cancer occurs in LMICs
85
Health inequity Social injustice
Low Health Literacybull Traditional misconceptions
about cancer are commonbull Stigma limits help seeking
Limited Accessbull Few women in LMICs have
adequate screeningbull Cervical cancer is the most
prevalent womenrsquos cancerin 37 countries
Imprecise Screening Testsbull 3 strategiesbull All with pros and consbull All require organized
health systems
Precancer Treatment Hard to Scale bull 2 approachesbull Excision requires more training
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Work in Progress
bull Integrating same-day HPV screening and treatment into routine care
bull Exploring womenrsquos preferences for cervical cancer screening using a discrete choice experiment (D43 TW009340)
bull Improving precancer treatment for high-risk womenbull AMC-099 A randomized placebo-controlled trial of 9vHPV
vaccination to reduce cervical HSIL among HIV-infected women (UM1 CA121947 Suppl)
bull HI 5 HIV-infected women treated with neoadjuvant topical 5FU for cervical HSIL (under review)
bull Training early-career womenrsquos health researchers
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Focus Areasbull HIV and womenrsquos reproductive health
bull Pregnancybull Contraceptionbull Cervical cancer
PhD Training (5)bull Three-year program
bull Coursework at Witsbull Dissertation research embedded in ongoing WRH projects in Zambia
Postdoctoral Training (5)bull One-year program
bull Research embedded in ongoing WRH projects in Zambia
Capacity Building Awards bull Annual call for applications
bull Support for workshopsshort courses training attachments infrastructure travel scholarships
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Things Irsquom Always Working On
bull Staying focused
bull Maintaining perspective
bull Practicing patience
bull Speaking up
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Next Steps
Post-fellowship activitiesmdashexamples new position Residency etc
Sabi Sands MP South Africa
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Catalyzing Innovation for Global Health
Presented byDr Jeffrey M BlanderChief Innovation OfficerPresidentrsquos Emergency Plan for AIDS Relief (PEPFAR) Office of The Global AIDS Coordinator and Health DiplomacyUS Department of State
March 2018Dedicated to the bright memory of Dr Melissa Ketunuti Fogarty-Ellison scholar Botswana 2005
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Personal BackgroundAcademic Training ScD Harvard TH Chan School of Public Health MS Harvard TH Chan School of Public Health BS Wharton School University of Pennsylvania
Fogarty Fellowship Site (Pre and Post Doctorate) Muhimbili University of Health and Applied Sciences 0506 and 0810
Fogarty-Funded Research Projects and Related Outputs A Randomized Controlled Trial Evaluating the Effect of an Interactive Group
Counseling Intervention for HIV Positive Women on Pre-natal Depression A Group Counseling Intervention To Promote Disclosure of HIV Status Among
Pregnant Women in Dar es Salaam Tanzania A Longitudinal Cohort Study Assessing the Uptake of Voluntary Counseling and
Testing Services to Prevent Vertical Transmission of HIV in Tanzania Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in
Tanzanian HIV-Infected Patients Burden of disease and barriers to the diagnosis and treatment of group a beta-
hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania
Mentors Professors Wafaie Fawzi Mary Kay Wafazi Warner Slack Uktan Demerci Sylvia Kaaya Ferdinand Mugusi Said Aboud Maulidi Fataki R Kaushik and M Janabi
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Publications Resulting from Training Program
Articlesbull Finkelstein SN Horowitz GL Diamond DV Bartels P Joseph J Hartman L Blander JM Slack WV
(March 2017) Rapid Streptococcal Antigen Detection Test Performed by Parents of Children with Sore Throat J Participat Med 2017 Mar 25 9e5
bull Kaaya SF Blander J Antelman G Cyprian F Emmons KM Matsumoto K Chopyak E Levine M Smith Fawzi MC (Feb 2013) Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status AIDS Care 25(7)854-62
bull Moon S Gurkan UA Blander J Fawzi WW Aboud S et al (July 2011) Enumeration of CD4+ T-Cells Using a Portable Microchip Count Platform in Tanzanian HIV-Infected Patients PLoS ONE 6(7) e21409 doi101371journalpone0021409
bull Bergmark R Bergmark B Blander J Fataki M Janabi M (Dec 2010) Burden of disease and barriers to the diagnosis and treatment of group a beta-hemolytic streptococcal pharyngitis for the prevention of rheumatic heart disease in Dar Es Salaam Tanzania Pediatr Infect Dis J29(12)1135-7
Booksbull Portable Microfluidic Diagnostics ndash Applications for Human Health Editors R Langer U Demirci A
Khademhosseini J Blander February 2013 World Scientific Publishing
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of
HIV status (AIDS Care 2013)
Background In sub-Saharan Africa the incidence of HIV infection has significantly decreased in
the past 10 years due in part to increasing access to antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT)-plus services (UNAIDS 2011)
Adherence to antiretro viral regimens is essential to ensure good outcomes (Bangsberg et al 2001 Nachega et al 2006) however depression can have a negative impact on adherence access to HIV care and disease progression (Farley et al 2010 Leserman 2008 Nel amp Kagee 2011)
Aims To assess the effectiveness of group counseling on reducing depressive symptoms
and increasing prenatal disclosure rates of HIV status among HIV positive pregnant women living in Dar es Salaam Tanzania
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Example 1 Continued ndash Results and Discussion
Results
Sixty percent of women in the intervention group were depressed post-intervention versus 73 in the control group [Relative Risk (RR) 082 95 confidence interval (CI) 067101 p0066]
Among those women who disclosed there was a significantly higher level of overall personal satisfaction with the response to disclosure from family and friends among women in the treatment (88) compared to the control group (62 p0004)
Discussion
bull The results indicate reductions in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention
bull This study suggests that the counseling sessions have likely reduced the burden of depression and helped clients better manage partner reactions to disclosure
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Background CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected
patients The World Health Organization (WHO) has recommended that a point-of-care reliable and affordable CD4 count platform is urgently needed in resource-scarce settings
Methods HIV-infected patient blood samples were tested at the point-of-care using a portable and label-
free microchip CD4 count platform that we have developed A total of 130 HIV-infected patient samples were collected that included 16 de-identified left
over blood samples from Brigham and Womenrsquos Hospital (BWH) and 114 left over samples from Muhimbili University of Health and Allied Sciences (MUHAS) enrolled in the HIV and AIDS care and treatment centers in the City of Dar es Salaam Tanzania
The two data groups from BWH and MUHAS were analyzed and compared to the commonly accepted CD4 count reference method (FACSCalibur system)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
(a) Unpacking of the microfluidic chips
(b) Antibody injection
(c) One step blood injection
(d) Microfluidic CD4 count chip imaging using a point-of-care portable battery operated lens less CCD based imaging platform
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Example 2 Continued ndash Results and Discussion
Results
The portable battery operated and microscope-free microchip platform developed showed significant correlation in CD4 counts compared with FACSCalibur system both at BWH (r = 094 p001) and MUHAS (r = 049 p001) which was supported by the Bland-Altman methods comparison analysis
The device rapidly produced CD4 count within 10 minutes using an in-house developed automated cell counting program
Discussion
We obtained CD4 counts of HIV-infected patients using a portable platform which is an inexpensive ($1 material cost) and disposable microchip that uses whole blood sample (10 ml) without any pre-processing
The system operates without the need for antibody-based fluorescent labeling and expensive fluorescent illumination and microscope setup
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Lessons Learned
ldquoThe best way to predict your future is to create itrdquo - Abraham Lincoln
ldquoI was taught that the way of progress was neither swift nor easyrdquo - Marie Curie
Logic will get you from A to Z imagination will get you everywhererdquo ndash A Einstein
ldquoIf today were the last day of my life would I want to do what Im about to do todayrdquo - Steve Jobs
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Next Steps ndash Part I
Founder amp President Bienmoyo Foundation HST939 Course Director Translational Research Fellow (Brigham amp Womenrsquos Hospital) Development of mHealth (mMaisha) platform to decentralize facility
based care and treatment services for maternal and child health Supported the Private Health Facilities of Tanzania to launch the Private
Medical Practice Development Fund to help owners from over 300 health facilities to establish quality (CQI) patient care systems
Supported Muhimbili National Hospital in the development of the business and strategic plans for a National Cardiac Care Center
Designed and implemented a national study in Tanzania to improve human resources for health
Recipient of emerging education leadership award for outstanding performance for impacting students leaders in global health practice
Translational research to deploy microfluidic devices on African Continent for CD4 and Viral Load
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Present Day
106
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
The Journey Continueshelliphellip
107
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
Example 2 Enumeration of CD4+ T-Cells Using a Portable MicrochipCount Platform in Tanzanian HIV-Infected Patients (PLoS ONE 2011)
Figure 1 ndash Overview of Microfluidic CD4 counting chip preparation blood injection and lensless imaging procedures by minimally trained personnel at MUHAS
Example 2 Continued ndash Results and Discussion
Lessons Learned
Next Steps ndash Part I
Present Day
The Journey Continueshelliphellip
Asante sana
Asante sana
NIH Fogarty International Center Pathways to Global Health Research Careers Yesterday Today and Tomorrow
Understanding the Invisible Scars of Ebola Mental Health and Resiliency in Liberia
Personal Background
Background
Background
Specific Aims
Methods
Slide Number 8
Preliminary Results
Slide Number 10
Preliminary Results
Lessons Learned amp Advice
Next Steps
Slide Number 14
Slide Number 15
Navigating a career through the worldrsquos largest tuberculosis epidemic
Personal background
Mentors and Collaborators
Slide Number 19
The Cascade of Care Model
Methods National Care Cascade
Cascade for all forms of TB in India 2013
Multidrug-resistant TB cascade 2013
Main findings Overall Cascade
Methods Pretreatment loss to follow-up in Chennai
Where are Chennairsquos TB patients coming from
Slide Number 27
Pretreatment Loss to Follow-Up Findings
Cascade for Advocacy Media Coverage
Lessons learned and advice
Post-Fogarty Outcomes
Building local research capacity to impact care of acutely ill sickle cell individuals in LIC Experience from Tanzania
Financial Disclosure
Slide Number 34
Personal Background
Background
Specific Aims
Study setting - Muhimbili National Hospital
Patient demographics
Patientsrsquo baseline variables and presenting complaints
Investigations ordered in the ED
Patientsrsquo disposition and hospital outcomes
Lessons Learned and Advice
Next Steps
Thank you
Postpartum Infections in Uganda
Personal Background
Personal Background
Personal Background
Study Background
Study Background
Study Background
Study Background
Specific Aims
Methods
Slide Number 56
Research Results
Research Results
Research Results
Slide Number 60
Research Results
Research Results
Research Results
Research Results
Slide Number 65
Lessons Learned amp Advice
Lessons Learned
Next Steps
Slide Number 69
Lessons from Neurogenetics Research in a developing country
Personal Background
Interpreting neurogenetics under ldquoglobal perspectiverdquo
Neurogenetics and Global Health why
HD in Peru major research contributions
Global Health strategy for a rare disorder HD Outreach clinic
Studying PD in mestizo Peruvian population
Lessons Learned amp Advice
Next Steps
Leveraging FICRF training to improve cervical cancer prevention in Southern Africa
Academic Background
Slide Number 81
Slide Number 82
Slide Number 83
Worldwide cervical cancer incidence528000 cases of cervical cancer (2012)
Slide Number 85
Improving Access to Care
Slide Number 87
Current Screening Strategies
Simplifying Screening
Slide Number 90
Work in Progress
Slide Number 92
Things Irsquom Always Working On
Next Steps
Catalyzing Innovation for Global Health
Personal Background
Publications Resulting from Training Program
Example 1 RCT evaluating the effect of an interactive group counseling intervention for HIV positive women on prenatal depression and disclosure of HIV status (AIDS Care 2013)
![Estate of Rolland Bastien Appellant Succession Rolland Bastien … · 710 BASTIEN ESTATEv. CANADA [2011] 2 S.C.R. Estate of Rolland Bastien Appellant v. Her Majesty The Queen Respondent](https://img.pdfslide.us/doc/110x75/5b64f7957f8b9a687e8e1785/estate-of-rolland-bastien-appellant-succession-rolland-bastien-710-bastien-estatev.jpg)
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![[Bastien James] Bastien Piano Basics Theory Level (Bookos.org)](https://img.pdfslide.us/doc/110x75/55cf9af6550346d033a43244/bastien-james-bastien-piano-basics-theory-level-bookosorg.jpg)
