Sparkman Center Program Director, Anna Helova, Visits Panama

A group of UAB faculty, staff and Anna Helova traveled to Panama City and Chitre, Panama from August 19-24, 2018. The visiting colleagues included:

        -Dr. Suzanne Austin, Senior Vice Provost & Senior International Officer

        -Dr. Lisa McCormick, Office of Public Health Practice, School of Public Health

        -Dr. Majd Zayzafoon, Assistant Provost, International Affairs, School of Medicine

        -Ms. Meena Nabavi, Office of Public Health Practice, School of Public Health

During this visit Anna Helova and the others met with University of South Florida (USF) Health Office – Dr. Arlene Calvo and Ms. Aracely Quintero – to facilitate future programs for UAB Students including the UAB Faculty-Led trip to Panama and Exploring Population Health for Summer 2019. Other future plans include research and internship opportunities for undergraduate, graduate, and professional students, facilitated by the Sparkman Center for Global Health.

The UAB colleagues visited historically and culturally significant sites, urban and rural communities, and community-based organizations. They also visited health care centers, hospitals, and schools to help better understand the community needs, learn the historical and contemporary public health issues, and how public health systems are working to solve the health issues affecting Panama today. Listed below are the different sites and locations visited by the team.

 

Panama 3 Rooftop view of Panama City (old town)

Panama 1 Remedios Elementary School in Chitre, Panama

City of KnowledgeCiudad del Saber (City of Knowledge) located across from the Panama Canal from the Pacific side

 

Panama 10Chitre Ministry of Health

Panama 4Las Mananitas Health Center

Panama 13Hospital el Vigia in Chitre, Panama

 
 

During the months of May and August annually, students embark on a global health and development journey to learn about challenges that pertain to food and nutrition, water and sanitation, and alternative energies in developing countries. The Southern Institute for Appropriate Technology (SIFAT) field course provides an opportunity for students to gain hands-on skills with various appropriate technologies that are used to combat malnutrition and sanitation challenges in low and middle-income countries (LMIC). SIFAT also covers topics such as microenterprise development, conflict resolution and cross-cultural training. There are two field course options for SIFAT: May (2-week course) and August (1-week course). Students can receive academic credit for both courses. The May course is a total of 6 credit hours; the August course is 3 credit hours. To learn more about SIFAT, check out their website here. To learn more about the 2018 SIFAT student experience, check out the videos below:

 

 

 

 

Despite the potential for antiretroviral therapy to improve maternal health and reduce mother-to-child transmission of HIV to as low as 1%, HIV-related maternal deaths and HIV infection among infants remain unacceptably high across sub-Saharan Africa. This is particularly true in Kenya, where crucial drop-offs occur in the cascade of prevention of mother-to-child transmission (PMTCT) services. Weak health systems contribute to insufficient service coverage, but many barriers lie beyond the clinic—in the partner, family, and community factors that shape women’s health decisions. The investigative team’s research in a high HIV prevalence area of southwestern Kenya has shown that many women avoid couples HIV testing and do not adhere to PMTCT regimens because they fear negative consequences from a male partner. Men can play a crucial supportive role for family health, but male partners in Kenya are poorly engaged in antenatal care and uptake of couples HIV testing during pregnancy is low. Pregnant women desire to be tested for HIV together with their partner and need the support for mutual disclosure involved in couples HIV testing and counseling (CHTC), regardless of whether they know their own HIV status

In this context, the investigative team proposes to test the efficacy of an interdependence theory-based couples intervention that reaches pregnant women and male partners through home visits by male-female pairs of lay health workers, and includes offer of home-based CHTC services. The randomized pilot study of this intervention with 96 pregnant couples (R34MH102103) demonstrated significant increases in uptake of couples testing (64% in intervention vs. 23% in control, p<0.001) and significant improvements in health behaviors such as exclusive breastfeeding and postpartum care. The investigative team now proposes a more robust investigation to determine whether this intervention improves uptake of couples HIV testing and health outcomes over and above less intensive male engagement strategies being used in the region.

They propose to conduct a three-arm trial among 1080 pregnant women and partners, randomizing them to home-based couple visits, HIV self-test (HIVST) kits to use with their male partner, or standard care (male partner clinic invitation letters), following couples up to 18 months postpartum. In Aim 1, they will determine the effects of the intervention on our primary outcome of couple HIV testing, compared to HIVST kits and standard care. In Aim 2, they will examine intervention impact on HIV prevention behaviors, facility delivery, and postnatal healthcare utilization. Among couples living with HIV, secondary outcomes include maternal VL suppression and HIV-free child survival up to 18 months. In Aim 3, the investigative team will compare the cost-effectiveness of the home-based couples intervention to the less resource-intensive strategies used in the other two study arms. The team's theory-based couples intervention has strong potential to increase couple HIV testing and collaboration for family health. This study will inform decision-makers about cost-effective strategies to engage pregnant couples in PMTCT and family health, with important downstream benefits for maternal, paternal, and infant health.

INVESTIGATORS AND INSTITUTIONAL AFFILIATIONS:

Name

Organization

Role on Project

Janet Turan, PhD, MPH

University of Alabama at Birmingham (UAB)

Principal Investigator

Lynae Darbes, PhD

University of Michigan (UM)

Co-Principal Investigator

Thomas Braun, PhD

University of Michigan (UM)

Co-Investigator

Elizabeth Bukusi, MBChB, M.MED, PhD, MPH, PGD, MBE

Kenya Medical Research Institute (KEMRI)

Co-Investigator

Abigail Hatcher, PhD

University of the Witwatersrand

Co-Investigator

Meredith Kilgore, PhD

University of Alabama at Birmingham (UAB)

Co-Investigator

Zachary Kwena, PhD

Kenya Medical Research Institute (KEMRI)

Site Principal Investigator

Harsha Thirumurthy, PhD

University of Pennsylvania

Co-Investigator

 

 

In the summer of 2017, the Sparkman Center for Global Health provided an opportunity for Ms. Mugdha Mokashi to complete an internship in Santo Domingo, Dominican Republic. The internship provided an opportunity for Ms. Mokashi to further her research interests regarding public health, policy and health outcomes. The Sparkman Center for Global Health would like to highlight Ms. Mokashi's achievement and her career path in relation to the healthcare needs of marginalized individuals. To read Ms. Mokashi's account of her career path, please view the piece below:

"Instead of planning pool parties and sleepovers in high school, I threw viewing parties (complete with popcorn) for election nights and speeches. I listened to NPR politics podcasts nightly from eighth grade to this day: a testament to my lifelong fascination with public policy. While science and healthcare were always my primary academic interests, I was still drawn to policy and public service in undergrad. I sensed there was more to human health beyond textbook biology, and pursued it by diving into the fast-track MPH program after my freshman year of undergrad. While learning intervention design and exploring how policies and social norms shape health behavior, I realized how much Iloved public health research. Outside of classes, I worked with social justice organizations that emphasized the link between policy and health. Serving on theboard of a reproductive rights-focused nonprofit and lobbying for sex education reform during college showed me how public health and policy were intertwined with health outcomes. When I began working in the field of reproductive rights, I began to recognize the wide economic and racial disparity in access to healthcare services surrounding reproduction, contraception, and sexual health. These experiences led me to pursue my MPH internship. My goal for this experience was to gain a broader perspective on the healthcare needs of marginalized individuals.

During this summer internship, I worked with the Caribbean Vulnerable Communities Coalition (CVCC), an NGO in Santo Domingo, Dominican Republic. The Sparkman Center for Global Health served as a partner to this organization for our project, and subsequently gave me full funding to be there. I worked primarily with Dr. Henna Budhwani from UAB, Dr. John Waters from the CVCC, and Elaine McLoughlin, a former MPH student from UAB that was working at the CVCC. Our objective was to conduct a population size estimate for sexual minority populations and female sex workers in the Dominican Republic. This estimate will be used to determine if local resources are adequately targeted to meet the population need of HIV prevention and treatment. My work specifically involved developing surveys as part of a formative assessment in order to use this data to develop sub-population profiles through population mapping. I also conducted a literature review to inform further research about these Caribbean populations and their HIV risks.

This internship was an incredible experience for me. I was pushed out of my comfort zone by working in a Spanish-speaking country, which gave me the opportunity to improve my language skills. I also got to experience real-world incorporation of cultural competency skills into practice and learned to translate research expertise into an actual study design. These skills will be invaluable for my future career in research and academia, especially within a global health context. This fall, I will be attending Harvard Medical School in pursuit of an M.D. I hope to use my medical training and public health research experience to advocate for reproductive health policy that impacts marginalized women and LGBTQ communities."

 

-Author: Mugdha Mokashi

 Sparkman Spotlight Mugdha Mokashi