GloCal Fellows 2018-2019
June Barrera, UC Davis
June P. Barrera, DVM, is a graduate from UC Davis School of Veterinary Medicine. During her veterinary education, Dr. Barrera participated in international research projects and training in Uganda, Tanzania and Rwanda to assess One Health issues, like food security and zoonoses, in agricultural and pastoral communities living in close proximity to wildlife. Passionate about One Health, Dr. Barrera’s short-term goal is to investigate drivers that increase emerging zoonotic risk in communities with a high wildlife-livestock-human interface. By understanding the ecology of such an interface, effective global health policies and practices can be developed to contain and limit emerging zoonoses. She also aims to ultimately make global healthcare more sustainable by promoting and encouraging the public to practice preventive health measures not only for themselves, but also their animals, particularly food animals.
Viral Sharing Between Animals & Humans: Implications for Spillover in Tanzania
About 75% of emerging infectious diseases (EIDs) with pandemic/epidemic risk originate in animals, both wildlife and domestic. Because the frequency and environmental conditions in which humans and animals interact affect disease ecology, critical animal-human-environment interfaces pose a threat to global health. To tease apart how animal, human and environment interactions influence the risk of EIDs, Dr. Barrera will assess the prevalence of viruses associated with pandemic risk in Tanzanian livestock. Viruses will be identified using consensus PCR and whole genome sequencing. Dr. Barrera will also investigate viral spillover between animals and humans by cross-referencing the viruses detected in her livestock samples with those previously identified in humans and wildlife sampled in the same region. By enhancing our understanding of viral transmission and disease risk at high wildlife-livestock-human interfaces, this study will provide a more comprehensive surveillance of EIDs.
Mentors: Jonna Mazet, DVM, MPVM, PhD (UC Davis), Rudovick Kazwala, DVM, MVM, PhD (Sokoine University of Agriculture), Dr. Subhash Morzaria , BVSc, MSc, PhD, CIBiol, MRCVS (FAO)
Jaeson Calla, Universidad Peruana Cayetano Heredia (UPCH)
Jaeson Calla, PhD, is a postdoctoral fellow at UPCH as well as a postdoctoral researcher in the UC San Diego School of Medicine. He obtained his Masters in Biochemistry and Molecular Biology at UPCH and his PhD in Infectomics and Molecular Pathogenesis at the Center for Research and Advanced Studies of the National Polytechnic Institute (CINVESTAV) in Mexico City. Dr. Calla’s early research focused on identifying new microbiological and molecular methods to diagnose Mycobacterium tuberculosis. His later graduate research was devoted to identifying mechanisms of gene regulation in organisms causing infectious parasitic disease. During the past few years, Dr. Calla has been conducting research on malaria, under the supervision and mentoring of Dr. Elizabeth Winzeler, aimed at identifying biomarkers of Plasmodium vivax infection in the human host cells as well as discovering new compounds that might prevent and eliminate malaria. His scholarly work has been supported by Medicines for Malaria Venture (MMV).
Universal biomarkers for Plasmodium vivax exoerythrocytic infection
Using dual RNAseq of flow-sorted infected cells, hundreds of upregulated human genes have been identified during infection by the model rodent malaria parasite, Plasmodium berghei. In order to determine whether these genes are also upregulated during infection with human pathogens, Dr. Calla’s research team plans to follow a group of fifteen proteins (receptors and surface membrane proteins), using HC04 cells and P. vivax sporozoites obtained from mosquitoes fed on blood from Peruvian P. vivax patients. Results will show if these human proteins can distinguish P. vivax infected from uninfected cells. The in vitro infection process will be developed in the “Satellite Laboratory” located in Iquitos, Peru, under the supervision of Dr. Joseph Vinetz (UC San Diego) and Dr. Dionicia Gamboa (UPCH). Through in vitro infection, the 20 most promising antimalarial compounds with potent activity across the entire parasite lifecycle will be evaluated; these were identified from phenotypic screens at UC San Diego under the supervision of Dr. Elizabeth Winzeler.
Mentors: Elizabeth Winzeler, PhD (UC San Diego), Dionicia Baziliza Gamboa Vilela, MSc, PhD (UPCH), Joseph Vinetz, MD (UC San Diego)
Rebecca DeBoer, UCSF
Rebecca (Becky) DeBoer, MD, MA, is a fellow in medical oncology and a Global Cancer Fellow at UCSF. She received her BA in Human Biology from Stanford and joint MD/MA in Medical Humanities and Bioethics from Northwestern. As a medical student she conducted a qualitative study in India about cancer treatment decision-making and research participation, which ultimately inspired her master’s thesis, “The Ethics of Global Cancer Care and Control.” She completed internal medicine residency at the University of Chicago and clinical ethics fellowship at the MacLean Center for Clinical Medical Ethics. After residency she worked as an oncology clinician at Butaro Hospital in Rwanda with Partners In Health for two years. She remains involved in oncology capacity-building projects in Rwanda and is now also working in Tanzania with the MUHAS-UCSF Cancer Collaboration. During her GloCal fellowship she looks forward to conducting ethics and implementation research in Rwanda and Tanzania.
Improving shared decision-making about palliative cancer therapy for HIV-related Kaposi sarcoma and other malignancies in Tanzania and Rwanda
Most cancer patients in sub-Saharan Africa present with advanced, incurable disease, and ensuring access to effective palliative chemotherapy and radiation is an important part of equitable cancer care. However, decisions about treatment of incurable disease are complex. At Ocean Road Cancer Institute (ORCI) in Tanzania and Butaro Hospital in rural Rwanda, physicians and nurses have identified decisions about palliative cancer therapy as among the most difficult clinical and ethical challenges they face on a day-to-day basis. The first aim of this project is to describe the experiences and beliefs related to decision-making about palliative cancer therapy among oncology physicians, nurses, and patients at ORCI and Butaro, comparing decisions about treatment of HIV-related Kaposi sarcoma with other cancers. The second aim is to develop and implement a decision tool targeted at providers that will facilitate shared decision-making at ORCI, Butaro, and comparable low-resource settings.
Mentors: Katherine Van Loon, MD, MPH (UCSF), Nazima Dharsee, MMed, MSc, MD (MUHAS), Anita Ho, PhD (UCSF)
Nyawira Gitahi-Kamau, Kenya Medical Research Institute (KEMRI)
Nyawira Gitahi-Kamau, MD, MPH is a young scientist whose research interest focuses on public health areas of HIV prevention and treatment, health system strengthening and emerging global health issues such as antimicrobial resistance. Her previous research carried out during her master’s degree looked at socioeconomic determinants of HIV disease progression among HIV discordant couples. She has been able to participate in various implementation science projects such as an evaluation of the adolescent HIV package of care in Kenya and the translation of research to policy in the country including adoption and roll-out of pre-exposure prophylaxis and guidelines for HIV prevention among adolescent key populations among others. She is a medical doctor (MBChB) from the University of Nairobi with a postgraduate degree in public health from Moi University. She is currently pursuing a PhD in global health from the Institute of Tropical Medicine and Infectious Disease (ITROMID), affiliated with KEMRI.
Evaluation of treatment outcomes after life skills provision among perinatally HIV-Infected adolescents receiving care in Kenya
Globally, HIV-related deaths fell by almost 40% between 2005-2016 for all age groups except adolescents. Adolescents are at a challenging developmental stage psychologically. Their needs for autonomy and independence and their evolving decisional capacity intersect. This makes it challenging to attract and sustain adolescents’ focus on maintaining their health, particularly for those with chronic illnesses like HIV. Transition by HIV infected adolescents from pediatric clinics to adult care requires attainment of certain life skills that enable the HIV positive adolescents to navigate the health care system successfully as adults. This includes the ability to cope with stigma, self-care and drug adherence as well as day-to-day routine activities. There is a need to evaluate the effect of life skills among HIV infected adolescents. This study will focus on evaluating these outcomes in a low resource setting and provide evidence on associated virological and psychological outcomes.
Mentors: Carol Camlin, PhD, MPH (UCSF), Elizabeth Bukusi, MBChB, MD, MPH, PhD (KEMRI), Colette (Coco) Auerswald, MD, MS (UC Berkeley)
Phillip Gorrindo, UCSF
Phillip Gorrindo, MD, PhD is an Ob/Gyn and physician-scientist. As part of the NIH Medical Scientist Training Program, he completed his PhD focused on translational neuroscience, exploring biologic and phenotypic heterogeneity in autism spectrum disorders. With a commitment to the profoundly positive effects of family planning – which empower women, lead to healthier children and mothers, and stronger families and communities – he recently completed his training in obstetrics and gynecology in Chicago, Illinois at Prentice Women’s Hospital of Northwestern University and Stroger Hospital of Cook County. He has particular interests in technological innovations that target barriers to sexual and reproductive healthcare, engaging men in women’s health, and gender-transformative interventions that serve as a foundation for sustainable attitude and behavior change.
A mHealth Platform for Sustainably Engaging Men in Family Planning Choices in an Area of High HIV Prevalence in Western Kenya
Among women in Sub-Saharan Africa who wish to avoid pregnancy, 60% are not using modern contraception. Unmet need for family planning (FP) is particularly salient among HIV-positive women in western Kenya. Increasingly the role of males in family planning choices is being studied, particularly regarding gender norms and relations, and how these contribute to male resistance to FP (MRFP). Working with the Kenya Medical Research Institute (KEMRI), the research team that Dr. Gorrindo is part of is currently piloting an intervention in Kisumu that attempts to shift gender norms toward lower MRFP among partnered female-male dyads. Prior work showed that MRFP is largely driven by fears of loss of masculinity. In Dr. Gorrindo’s project, he will build on this work and develop a mobile health (mHealth) digital platform for scalable and sustainable engagement of men in western Kenya that focuses on FP education, masculinity, and shifting gender norms.
Mentors: Sara Newmann, MD, MPH (UCSF), Louisa Ndunyu, PhD (KEMRI), Shari Dworkin, PhD, MS (University of Washington)
Nelson Kalema, Makerere University
Nelson Kalema, MBChB, MMed, MAS, completed his residency training in Internal Medicine at the College of Health Sciences, Makerere University in Kampala, Uganda, with support from the NIH-funded HIV/TB COHRE Program administered by the Joint Clinical Research Center. Between 2015-2017, a D43 HIV/TB Implementation Science grant supported Dr. Kalema to obtain additional Master’s Degree Training in Clinical Research (TICR Program) in the Implementation Science track, at the University of California, San Francisco. Previously, he has collaborated and published with UCSF faculty on TB research that sought to assess the performance of novel TB diagnostic tests, treatment strategies and outcomes in patients who presented with presumed TB at the Mulago National Referral Hospital. Currently, Dr. Kalema is a research fellow at the Infectious Diseases Institute (IDI) working with stakeholders in the Outreach Program to identify key implementation science gaps/bottlenecks, opportunities and strategies in HIV/TB Prevention and Care.
Mapping and Understanding Gaps in the latent TB cascade of care - provision of isoniazid preventive therapy to persons registering for HIV care in Uganda: The MUG study.
Dr. Kalema’s study will focus on Mapping and Understanding Gaps (MUG) in the latent TB cascade of care in HIV-positive persons linked to HIV care facilities in Uganda. While a third of the 34 million HIV-positive persons in the world are estimated to be co-infected with latent TB and 19 times more likely to develop active TB disease than their non-HIV counterparts, only 8.3% received the WHO-endorsed isoniazid preventive prophylaxis in 2015. The same year, TB accounted for approximately 30% of HIV-related deaths, mostly in Africa where 21 out of 30 high HIV-TB burden countries did not report on isoniazid preventive therapy (IPT) provision. IDI is leading efforts to improve IPT provision to HIV-positive persons initiating care at ART facilities in Uganda. Initial reports indicate limited success and uptake is still unclear. Dr. Kalema proposes to use mixed-methods to quantify and describe quality gaps in the latent-TB cascade of care and use implementation science frameworks (TDF/CFIR) to understand and propose future interventions.
Mentors: Adithya Cattamanchi, MD, MAS (UCSF), Aggrey Semeere, MBchB, MMed, MAS (Makerere Univeristy), Mari Armstrong-Hough, PhD, MPH (Yale)
Zachary Madewell, UC San Diego
Zachary Madewell is a third year PhD student in public health (epidemiology) at UC San Diego. Mr. Madewell graduated from San Diego State University with a MPH in epidemiology. As an undergraduate at the University of California, Santa Barbara, and the University of Queensland, Zach majored in computer science. Mr. Madewell’s immediate objectives are to build on his graduate education in epidemiology, undergraduate training in computer science, and his field experiences in South Africa, China, Brazil, Jamaica, Mexico, and Puerto Rico, to conduct research on epidemic and endemic diseases that transcend geographical borders. His long term career aims are in academic research and teaching with a focus on global health in the developing world.
The use of ovitraps for Aedes spp. control and arboviral surveillance
Chikungunya, dengue, and Zika virus are flaviviruses mainly transmitted by the Aedes aegypti or Aedes albopictus mosquitoes. Outbreaks of arboviruses in Guatemala indicate that vector control is not being achieved. Control of arboviruses depends upon timely and accurate detection of elevated viral activity. Mosquito surveillance involves systematic collection of mosquito samples and testing for viruses to inform vector control. This surveillance may provide information on the mosquito population density, resistance to insecticides, efficacy of traps, and location of breeding sites. In Guatemala, ovitraps are used as surveillance tools to monitor gravid mosquito populations for arboviruses. For his project, Mr. Madewell will evaluate the effectiveness of ovitraps for the detection and control of arboviruses.
Mentors: Kimberly Brouwer, PhD (UC San Diego), Norma Padilla, PhD, MSc (Universidad del Valle de Guatemala), Stephen Waterman, MD, MPH (CDC / UC San Diego)
Emmanuel Kiiza Mwesiga, Makerere University
Emmanuel Mwesiga, MBChB, MMed, is an early career psychiatrist from Uganda. He is also a lecturer and head of psychiatry undergraduate training in the Department of Psychiatry at Makerere University. Dr. Mwesiga received his bachelor’s degree from Mbarara University of Science and Technology and completed his specialist training in Psychiatry from Makerere University. Currently, he is pursuing his doctoral degree in psychiatry from the University of Cape Town. Dr. Mwesiga has a passion for clinical research with particular interest in early intervention psychiatry. His current research interests involve epidemiological, clinical and neuroscience descriptions of the first episode of psychosis in Uganda.
Influence of alternative and traditional therapies and other factors on duration of untreated psychosis among patients with a first episode of psychosis in Uganda: A mixed methods study.
Psychotic disorders are among the leading contributors to adult mental illness and disease burden globally. Early and sustained treatment with antipsychotic medication leads to better outcomes. There is, however, usually a delay between onset of psychotic symptoms and initiation of antipsychotic medication defined as the “duration of untreated psychosis” (DUP). The burden of DUP in the Ugandan setting and the factors associated are not well described. Also many patients in this setting first seek care from alternative and complementary therapies (ACTs). It is not clear how previous use of ACT affects delay for initiation of care or desire for continued treatment with antipsychotic medication. We hypothesize that socio-demographic and mental health factors as well as prior interaction with ACT are associated with longer DUP. Dr. Mwesiga and his research team will undertake a mixed methods study at Butabika Hospital in Uganda to summarize the factors associated and the influence of ACT on DUP in patients with psychosis.
Mentors: Susan Meffert, MD (UCSF), Noeline Nakasujja, MbChB, MMed, PhD (Makerere University), Rachel Loewy, PhD (UCSF)
Vincent Ofori, UCLA
Vincent B. Ofori is a medical student at Charles R. Drew University and the David Geffen School of Medicine at UCLA. His interests are centered around the intersection of HIV, social support systems, and mental health disorders. As a former site director for the PATH-PrEP demonstration project at UCLA, he gained invaluable insight into operationalizing pre-exposure prophylaxis for HIV prevention. He also developed an interest in assessing barriers to HIV screening, adherence to treatment, and the influence of social networks and belief systems on health maintenance. He is actively engaged in global health activities through the Panamanian-based non-profit Floating Doctors, serving as program coordinator for The Young Scholars Program. Mr. Ofori holds a BS from St. Edward’s University.
Assessing the Influence of Stigma and Social Network on the Utilization of Pre-exposure Prophylaxis (PrEP) as a HIV Prevention Strategy in Peru
The international research community acknowledges that pre-exposure prophylaxis (PrEP) is a highly effective prevention intervention for those most at risk of HIV infection. Latin America currently lacks policy regarding PrEP; however, the ImPrEP Demonstration Project - a strategic partnership between Brazil, Mexico and Peru - seeks to operationalize and assess PrEP uptake in public health settings. Current literature suggests that PrEP utilization and adherence is influenced by stigma, yet there is a paucity of research examining the scope of its effect. Mr. Ofori’s research will assess PrEP-related stigma and its relationship to adherence. The project will also examine the effect of social environment on decision-making with regard to PrEP utilization. Project goals include investigating criteria to be used in developing a validated PrEP-related stigma scale relevant to Latin America.
Mentors: Dr. Jeffrey Klausner, MD, MPH (UCLA), Carlos F. Caceres, MD, MPH, PhD (UPCH), Kelika Konda, PhD (UCLA)
Guillermo Salvatierra Rodríguez, UPCH
Guillermo Salvatierra Rodríguez, DVM, is a researcher and member of the Microbial Genomics Laboratory, at UPCH. His postgraduate studies in Molecular Biology and Epidemiology Research combine training in veterinary medicine, molecular microbiology and epidemiology. Dr. Salvatierra's research lies at the interface of genomics, public health and infectious disease epidemiology and is currently supporting projects on molecular typing and genomic surveillance of bacterial pathogens in Peruvian communities. Dr. Salvatierra worked at the Peruvian Ministry of Health for zoonotic diseases surveillance and outbreak research. He is a young Peruvian scientist with interest in infectious diseases affecting Latin American populations and is eager to apply it to new projects that address issues relevant to Peruvian public health.
Molecular epidemiology of antimicrobial resistant Salmonella spp. isolates from poultry production as a risk for human health in Lima, Peru
The prevalence of antibiotic-resistant salmonellosis has increased in recent years in Peru. These food-borne infections have been associated with typhoid fever and bacteremia in community and hospital settings. Dr. Salvatierra will use microbiological and whole-genome sequencing for the characterization and genetic diversity identification between poultry and human Salmonella isolates. He will create a resistance exchange network to obtain strong epidemiological data to investigate their phylogenetic relationships and to establish their relatedness. The results will allow a significant improvement in Salmonella detection and source trace-back, and will contribute to the design of critical control programs in Peruvian poultry to improve good practice measures and prevent potential human infections in Peru.
Mentors: Kelika Anne Konda, PhD (UCLA) Pablo Tsukayama, MsC, PhD (UPCH), Andrés (Willy) Lescano, PhD, MHS (UPCH)
Archana Siddaiah, St. John’s Research Institute (SJRI)
Archana Siddaiah, MD, completed her medical school training at the Mysore Medical College and Research Institute. Due to her interest in the field of public health, post-graduation she went on to pursue Community Medicine from the All India Institute of Medical Sciences wherein she undertook roles of an administrator, researcher, and academician. Her main areas of interest include maternal and child health, adolescent health, and health systems research. Previously Dr. Siddaiah worked with the public health systems of India in improving existing adolescent reproductive and sexual health. In 2017 she was selected for the South East Asian Union/MSF SORT IT (Médecins sans Fronterès Structured Operational Research and Training IniTiative) course and successfully completed it. Currently, she is working as faculty member and is mentoring a Fulbright Fellow from Wake Forest University. In the long run she is interested in the development, implementation, and dissemination of ideas for addressing global health issues especially in low income communities.
Feasibility and Effectiveness of Training Health Workers in providing Primary Mental Healthcare to Adolescents in Rural South India
Research has shown that mental health problems such as anxiety, depression, and suicidal tendencies among adolescents are increasing. In India, the adolescent population, aged 10-19 years, constitutes around 20.9% of the total population. Suicide ranks among the three leading causes of mortality among young people. Adolescents face many barriers in obtaining mental health services from the existing hospitals, including scarcity of psychiatrists. Health workers play an important role in providing mental health services in the community using standard diagnostic tools. To address the challenge of mental illness in resource constrained settings, the World Health Organization has developed a tool called Mental Health Gap Action Programme (mhGAP). Dr. Siddaiah’s research involves training health workers to use this tool to detect and manage some of the common mental health problems among adolescents. This should help in scaling up the existing health services available to adolescents.
Mentors: Maria Ekstrand, PhD (UCSF), K Srinivasan, MD (SJRI), Veena Satyanarayana, PhD (National Institute of Mental Health and Neurosciences)