GloCal Fellows 2022-2023

Mohamed Z. Alimohamed, MS, PhD, is a Lecturer at the Department of Haematology and Blood Transfusion and Department of Biochemistry (MUHAS), as well as a Research Fellow and lead investigator in the Sickle Cell Programme (SCP). His current research interests and work include investigating curative options (gene editing and therapy) as part of advanced therapy treatment for patients with sickle cell disease (SCD) in Tanzania, antimicrobial resistance in Tanzanian communities, exploring genetic variations in African populations and surveillance of rare genetic disorders in Tanzania. He serves as the secretary general of the Tanzania Human Genetics Organization (THGO) that he co-founded in 2017. During the course of his PhD studies, his research mainly focused on using next generation sequencing to diagnose (genetic) diseases such as cardiomyopathy, spinocerebellar ataxia, cancer and acute leukemia and its implementation strategies. He is passionate to push the genetics and genomics agenda in his country, Tanzania.

Project

Isolation, Quantification and Cryopreservation of CD34 Positive Cells from Cord Blood Samples – Methods Validation in Tanzania

Currently, the only curative option for SCD is allogenic hematopoietic stem cell transplantation. While the process is highly successful, there is limited availability in finding matched sibling donors as well as the high risk of transplantation related side effects. This has led scientists around the world to explore alternative curative options such as ex vivo gene therapy which has been shown to carry a great potential for cure. These techniques are however still in the early stages of research where issues such as safety and efficacy remain to be addressed before employing them in clinical practice. This makes the case for increasing scientific studies in Tanzania and Africa in general where the burden is high, to invest and keep par with the developed countries. The development of laboratory-based pipelines is strongly needed to establish the foundations of advanced therapy for sickle cell disease, particularly gene-based therapy as a potential curative option in Tanzania.

Mentors: Mark Walters, MD (UCSF), Julie Makani, MD, PhD, (MUHAS), Siana Nyka, PhD, MS (MUHAS)

mzahir@blood.ac.tz

Jonathan Izudi, MPH, PhD, is a public health specialist focused on operational and implementation sciences research. He was a Fogarty D43 Postdoctoral Research Fellow in HIV and co-infections at the Infectious Diseases Institute (IDI), Makerere University, and a 2021 Impact Evaluation Fellow of the East African Social Sciences Translation Collaborative (EASST) at the Center for Effective Global Action, University of California, Berkeley, USA. He researches TB, HIV, and maternal health. His methodological and statistical expertise is in systematic reviews and meta-analyses, randomized and non-randomized experimental designs, and the application of advanced statistical methods for causal inference and impact evaluation. He is a recipient of the 2022 Charles Boucher Award for the highest scoring scientific abstract submitted at the 16th INTEREST International Conference on HIV treatment, pathogenesis, and prevention research in low-resource settings as well as the best presenter.

Project

Effectiveness of Intensive Adherence Counselling on Viral Load Suppression among Adolescents and Adults Living with HIV in Uganda: a Regression Discontinuity Design

In People Living with HIV (PLHIV) on first-line ART, optimal ART adherence leads to viral load suppression (VL<1000 copies/ml) within 6 months. For those with VL≥1,000 copies/ml after 6 months of ART, intensive adherence counseling (IAC) is recommended before a definitive diagnosis of treatment failure at 12 months and switch to second-line ART is reached. In Uganda, data regarding the impact of IAC on VL suppression are inconclusive. Previous studies lacked appropriate comparison groups and employed a design that precluded assessment of impact of IAC besides data inadequacy regarding factors influencing VL non-suppression after IAC completion. Among adolescents and adults on ART with VL 1,000 copies/ml at 6 months in Kampala, Uganda, Dr. Izudi will evaluate the impact of IAC on VL suppression and all-cause mortality at 12 months, examine risk factors for VL persisting at≥1,000 copies/ml at 12 months after completing IAC and, explore facilitators and barriers to VL suppression at 12 months after completing IAC.

Mentors: Rachel King, MPH, PhD (UCSF), Barbara Castelnuovo, MD, MS, PhD (IDI), Addithya Cattamanchi, MD, MAS (UCSF)

jonahazd@gmail.com

Grant Murewanhema, MBChB, MMed, MPH is an Obstetrician-Gynecologist in the Department of Obstetrics and Gynaecology at the University of Zimbabwe (UZ), and an adjunct lecturer in Maternal and Child Health in the Department of Global Health. His work involves day-to-day provision of clinical services to patients at Sally Mugabe Hospital, and teaching medical students. He is a Chevening Scholarship alumnus, a researcher and an academic writer with over 50 peer-reviewed publications. He sits on FIGO’s Safe Abortion Committee, is the African Representative in the World Association of Trainees in Obstetrics and Gynaecology, and is the Deputy Chairperson of the Zimbabwe National Cervical Cancer Screening Taskforce. He is an Academic Editor for PLOS ONE and an Associate Editor for the Pan African Medical Journals. Currently, he is the co-investigator in a study evaluating the population level impact of HPV vaccination in Zimbabwe.

Project

Characterization of the vaginal microbiome among pregnant women presenting to antenatal clinics in Harare, Zimbabwe

The balance of the vaginal microflora is involved in the complex process of sustaining the conceptus in utero and maintaining the pregnancy until term. Vaginal dysbiosis is associated with adverse pregnancy outcomes, including pregnancy wastage, preterm delivery, and an increased risk of acquisition of HIV and other sexually transmitted infections. Among women in Zimbabwe, the prevalence of bacterial vaginosis in pregnancy was previously noted to be very high at 32.6%. Understanding the composition of the vaginal microbiome in this population is a critical step in understanding the contributory factors to vaginal dysbiosis, to investigate the association between dysbiosis and adverse pregnancy outcomes, and to design interventions to reduce the adverse outcomes associated with dysbiosis. The objective of this study is therefore to characterize the vaginal microbiome among women presenting to antenatal clinics at Sally Mugabe and Parirenyatwa Hospitals as a baseline study.

Mentors: Zvavahera (Mike) Chirenje, MD, MSc, FRCOG (UCSF), Felix Godwin Mhlanga, MBChB, MMed (UZ), Joelle Brown, PhD (UCSF)

gmurewanhema@yahoo.com

Caroline Ngimba, MD, MMed, is a staff pathologist at MNH, the largest national referral hospital in Tanzania and the affiliated teaching hospital for Muhimbili University of Health and Allied Sciences (MUHAS). She received her MD and MMed in anatomic pathology from MUHAS. Her work involves the provision of anatomical pathology services such as attending and reporting histology and cytology cases, performing autopsy, and supervising residents. Her previous experience in cancer research includes working as a data coordinator where she adapted the recently published Tanzanian National Cancer Treatment Guidelines into a smartphone application, AgileMD, with the goal of facilitating easy access to the reference guide as part of a larger project to increase adoption of these guidelines. She also worked as a study pathologist for the project that aimed to validate a point-of-care breast cancer biomarker test. She has interests in research that improves cancer diagnostic service in resource-limited settings.

Project

Implementing primary high risk HPV (hrHPV) testing for cervical cancer screening in regional care and treatment clinics (CTCs) for women living with HIV (WLHIV) in Tanzania

Cervical cancer is the leading cause of cancer related mortality among women in Tanzania. Visual inspection by acetic acid (VIA) is the current modality used for cervical cancer screening in Care and Treatment Clinics (CTCs) among WLHIV in Tanzania. Primary cervical cancer screening with hrHPV at the CTCs will increase the early detection and treatment of precancerous lesions. Primary HPV screening introduces room for self-sampling thereby reducing barriers to screening such as number of intrusive pelvic examinations and personnel required for screening, as only those with positive hrHPV results will be referred for triage and treatment as per WHO recommendations. This project will conduct a formative evaluation of the contextual factors, facilitators, and barriers for adopting hrHPV testing as primary cervical cancer screening modality and develop an intervention strategy for implementation of primary cervical cancer screening using hrHPV testing among WLHIV on these clinics.

Mentors: Megan Swanson, MD, MPH (UCSF), Elia Mmbaga, MD, PhD (MUHAS), Dianna L. Ng, MD (UCSF)

caroline2000tz@yahoo.com

Awirut Oon-arom, MD, is working as a psychiatrist and assistant professor in the Department of Psychiatry, Faculty of Medicine, CMU. After he received his MD from Ramathibodi Hospital at Mahidol University in Thailand in 2014, he received psychiatry training at Department of Psychiatry, CMU and then was certified in clinical practice in psychiatry by the Royal Collage of Psychiatrist of Thailand in 2018. Dr. Oon-arom’s research interests are substance use, suicide, co-occurring psychiatric disorders, and mental health in gender-diverse people, and their health consequences such as sexual health risks and HIV. He also collaborates with CMU Research Institute for Health Sciences on a project aimed to promote healthcare among university students by integrating knowledge of physical, mental, and sexual health. His career goal is to become an mHealth expert to address mental health problems in gender diverse people, focused on substance use and HIV across Thailand and Asia.

Project

Sexualized drug use among men who have sex with men (MSM) and the HIV pre-exposure prophylaxis care continuum in Thailand

Thailand has one of the highest prevalences of HIV in the Asia-Pacific region. HIV prevalence is highest among MSM. Although rates of new HIV infection among MSM are increasing, efforts to improve access to PrEP have been slow. Sexualized drug use (SDU) or chemsex increases HIV risk. The use of alcohol and drugs decreases inhibition, and associated with condomless intercourse, sex with multiple partners, higher frequency of sexual activity, and sexually transmitted infections. Greater exposure to these and other psychosocial syndemics is associated with HIV transmission and poor adherence to HIV treatment. Since smartphone dating app use is associated with SDU and is commonly use in Thailand, mobile health interventions to improve PrEP retention may be useful tools for MSM with SDU. Dr. Oon-arom’s research will focus on the effects of SDU among MSM and the HIV PrEP care continuum in Thailand with exploration of the potential role of mobile health interventions for PrEP.

Mentors: David Grelotti, MD (UCSD), KriengKrai Srithanaviboonchai, MD (CMU), Sung-Jae Lee, PhD (UCLA)

awirut.oonarom@cmu.ac.th

Rose Paneno is a medical student at David Geffen School of Medicine (UCLA). She received a Bachelor’s of Arts in biology and social welfare from UC Berkeley. Ms. Paneno is dedicated to advancing accessibility and quality of health care provision globally through community health workers (CHWs). Prior to matriculation at UCLA, she worked with organizations in Uganda and Zambia to facilitate training, data collection, and bolster institutional support of CHWs. While at UCLA, she founded LA Health Volunteer Corps and orchestrated local COVID-19 relief efforts. She has also participated in qualitative research highlighting provider and CHW prioritization of client needs utilizing Street Level Bureaucracy framework. Ms. Paneno is deeply interested in conducting research to inform community-driven interventions and strengthen health care delivery systems in disaster situations. She aspires to be a practicing physician and global health researcher focused on improving health system resiliency.

Project

Assessing the individual and health system factors influencing community health worker role-shift in response to El Niño Costero and COVID-19 Disasters in Lima and Piura, Peru: a mixed method, cross sectional analysis.

Ms. Paneno’s project will utilize a cross-sectional mixed methods study design to assess the relationship between community health worker disaster response, mental health, resiliency, social stigma, and health system integration in Lima and Piura, Peru. The overall aims of this proposed research are: (1) to explore mental health outcomes, resiliency, and level of COVID-19 response engagement among community health workers (2) Identify internal and external factors (mental health, resiliency, social stigma, and health system integration) that contributed to degree of role-shift to disaster response, and (3) to evaluate community social stigma towards community health workers following pandemic response. Findings from this preliminary data will potentially identify strengths and vulnerabilities within the current Peruvian CHW pandemic response and inform similar projects globally by highlighting strategies for optimal mobilization of CHWs in disaster response.

Mentors: Bonnie N. Kaiser, PhD (UCSD), Miya Barnett, PhD (UCSB), Lillian Walkover, PhD (UCSD), Andrés Lescano, PhD (UPCH), Kathryn Dovel, PhD (UCLA)

rpaneno@mednet.ucla.edu

Daniel Vladimir Eid Rodriguez received his PhD in public health at Umea University in Sweden with a project aimed to assess and improve health care access to patients with leishmaniasis in remote rural areas of the Bolivian rainforest. For 18 years, he has been participating in epidemiological studies on health and aging among the Tsimane, an indigenous group with a relatively traditional lifestyle. Despite high inflammation, Tsimane carry a low burden of dementia, atherosclerosis, hypertension, diabetes and obesity. Yet their environment and living conditions coupled with limited health care access bear witness to a high risk of treatable health problems that lead to disability and death. Dr. Rodríguez’ work during these years combined research with the improvement of their access to health care. His next step is to better understand the myriad of factors affecting the health of elders, including the role of relatives as caregivers, with the goal of developing interventions for elders’ well-being.

Project

Unveiling care needs of elders among indigenous Amazonians of Bolivia: A novel approach using a mixed method design

Older indigenous people (i.e. elders) have poorer health compared to their non-indigenous counterparts and face unique challenges affecting their well-being. The study population are the Tsimane, an isolated indigenous group still practicing traditional livelihood farming, fishing and hunting. This lifestyle is challenging for disabled elders given that hunting and farming require substantial strength and endurance. By age 60, Tsimane elders show substantial hearing loss, visual impairment, and other deficits. These functional disabilities make elders dependent on their families to survive, a situation rife with tension. The project aims to identify associated factors with functional dependence, and explore social consequences of functional decline, coping mechanisms, and patterns of caregiving. This project will contribute to the knowledge of cross-cultural aspects of eldercare including physical, social, and emotional well-being, as well as, to starting interventions to address their needs.

Mentors: Ladson Hinton, MD (UC Davis), Mariana Santa Cruz Terrazas, PhD (Universidad Católica Boliviana), Michael Gurven, PhD (UCSB)

d.eid@umss.edu

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