The Rakai Health Sciences Program (RHSP) in Uganda provides a unique setting for implementation science and operational research related to HIV/AIDS. The RHSP oversees HIV services in Rakai District and has conducted several studies evaluating different models of service delivery. Some examples included a trial of a demand generation approach to increase uptake of HIV/family planning services and studies examining determinants and impact of scaling up medical male circumcision. The RHSP also utilizes longitudinal cohort data to evaluate the impact of combination HIV prevention approaches and quantify HIV care cascades over time. This provides opportunities for collaborative research on improving health services and outcomes in the region.
Review from the 24th Conference on Retroviruses and Opportunistic Infections (CROI) – 2017
Charles Hicks, M.D.
April 21st, 2017
UCSD HIV & Global Health Rounds
Michael Tang, MD
Infectious Disease Fellow
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Review from the 24th Conference on Retroviruses and Opportunistic Infections (CROI) – 2017
Charles Hicks, M.D.
April 21st, 2017
UCSD HIV & Global Health Rounds
Michael Tang, MD
Infectious Disease Fellow
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Willingness of Disclosure of HIV Positive Status among Attendee of Integrated...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Willingness of Disclosure of HIV Positive Status among Attendee of Integrated...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Georgia State School of Public Health Ph.D. student Rachel Culbreth discussed her research into HIV and other diseases among young people living in slum communities in Kampala, Uganda, during the APHA 2016 annual meeting in Denver. This is her presentation.
Ben Bavinton, (The Kirby Institute) discusses how the Opposites Attract' stdy will address the unanswered questions about wther treatment as prevention will work for gay men. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Jill Blumenthal, MD
Assistant Professor of Medicine
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
HPV infection and anal dysplasia in Vancouver: findings from the ManCount Survey.CBRC
HPV infection and anal dysplasia in Vancouver: findings from the ManCount Survey. Presented by Mark Gilbert, BC CDC, at the 5th Annual Gay Men's Health Summit held in Vancouver, BC on November 9th and 10th, 2009.
Phillip Keen (Kirby Institute) discusses the successes and challenges of community-based HIV testing.
This presentation was given at the AFAO National HIV Forum, 17 October 2014.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Annette Verster, WHO
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Dr Paba Palihawadana, Chief Epidemiologist, World Hepatitis Day symposium was organized by the Sri Lanka College of Venereologists on world hepatitis day on 28. July 2015 at BMICH
NIH AIDS Executive Committee (NAEC) FY 2019 Ending the HIV Epidemic (EHE) in ...HopkinsCFAR
The NIH Office of AIDS Research (OAR) is pleased to release the NIH AIDS Executive Committee (NAEC) FY 2019 Ending the HIV Epidemic (EHE) in the U.S. Report.
NIMH funding on PrEP use Among Adolescent Girls and Young Women in sub-Sahara...HopkinsCFAR
Dr. Susannah Allison. Dr. Allison is a Program Officer at the National Institute of Mental Health within the Division of AIDS Research. She oversees a portfolio of research focused on the prevention of HIV infection among infants, children, and adolescents as well as research to enhance health outcomes among youth living with HIV. She is also the training director for the division. Prior to working at NIMH, Dr. Allison worked with children and families infected and affected by HIV in Baltimore, Miami, and Washington, DC. She completed her doctorate at George Washington University where she received her Ph.D. in Clinical Child Psychology with an emphasis in child health psychology.
High Sensitivity HIV Testing and Translational Science around PrEPHopkinsCFAR
Joanne Stekler, MD MPH
Associate Professor, Department of Medicine
University of Washington
Inter-Center for AIDS ResearchAntiretroviralsfor Prevention Working Group
November 13, 2017
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Rakai Health Sciences Program
- Initiated by Ugandan colleagues (Drs.
D Serwadda and N Sewankambo) in
1987
- Researchers at:
- Makerere University
- Uganda Virus Research Institute
- Johns Hopkins
- Columbia University, Karolinska,
University of Toronto,
University College London,
etc…
- NIH/NIAID (International Center
for Excellence in Research)
- Registered independent legal entity in
Uganda
- ~ 350 Ugandan colleagues and staff
3. Rakai Community Cohort Study: core of the RHSP
Observational research
(Quantitive / Qualitative)
- Community demography
- HIV epi/dynamics and spacial dynamics
- HIV/STI risk factors (biological and behavioral)
- Use of services
- STIs, OIs, malaria, NCD
- Social (Intimate partner violence, alcohol…)
- Time trends …. And much more
Randomized Trials
-STD control for HIV prevention& pregnancy
outcomes
- Male circ for HIVI prevention in men
- Male circ for HIV prevention in women
partners
- HSV-2 suppression for HIV progression
- Prevention of IPV and HIV (SHARE trial)
-Trial of demand generation (Stylish Man &
Woman)
Implementation
Science/Operations Research
P-MTCT, condoms, VCT, ART/HIV care
provision, male circumcision, family planning,
adolescent health, prevention of intimate partner
violence
Methods of improving service uptake and
adherence (peer programs, communication
technologies)
Service provision
-Combined HIV prevention, HIV/STI care and
treatment, family planning, some general health
care
Basic science (with an epi
flavor)
- Mucosal immunology, microbiology,
pathology, immunohistochemistry, HSV-2,
drug resistance, HSV-2, HPV
Molecular epi
- HIV Subtypes, HIV superinfection
- HIV phylogentics
- ART resistance
Clinical studies:
HIV related neurological outcomes
Liver fibrosis, CVD, kidney disease, etc…
4. Presentation of RHSP studies and resources
• Kate Grabowski:
– Cohort and key nested studies
• Aaron Tobian
– Lab studies and resources
• Larry Chang
– Clinical and HIV prevention studies, and
implementation science
• Maria Wawer
– Mop up
5. What we hope will come of this presentation
• Opportunities for you
– Secondary data analyses
– New setting for your current research interests and
ideas
– New research ideas
– Grants (!)
• Opportunities for RHSP
– New research ideas
– New collaborations (and grants )
– New expertise (substance abuse research, etc…)
6. The Rakai Community Cohort Study:
Overview and opportunities for population-based
HIV research and beyond in Rakai, Uganda
7. Rakai Community Cohort Study
(RCCS)
• Open population-based HIV
incidence cohort in 40-50 agricultural,
trading, and fishing communities in
Rakai District, Uganda
• ~15-17,000 study participants are
surveyed on an ~annual basis.
• Surveys ongoing since 1994.
• 16 survey rounds completed
• Fish communities surveyed beginning in
survey round 15
• N=4 fish landing sites (Dimu and Kansensero)
• Each survey includes household
census and individual interviews for
adults aged 15-49.
8. RCCS data overview
• Census
• Household membership
• Family relationships
• In/out migration
• Deaths and births
• GPS
• Socio-demographic and
behavioral survey
• Basic demographics
• Relationship history
• Egocentric Sexual networks
• Family planning
• Uptake of prevention interventions
• HIV/STI Testing
• Biological samples stored
• Qualitative data
• Focus groups, in-depth interviews
Survey Subject
Areas Captured
72,962
Total RCCS
Subjects
Research Data
16 Rounds of Study + Lab Data
Over 1,800 Questions
55,664 Households in Census
9. Prevalence
(%)
Incidence (per
100py)
General
Population
11 0.8
Fish Landing Sites 34 3.2
Table 1. Male HIV prevalence and incidence, 2012-2013
HIV incidence and prevalence in
the RCCS
Prevalence
(%)
Incidence (per
100py)
General
Population
17 1.0
Fish Landing Sites 49 3.7
Table 2. Female HIV prevalence and Incidence, 2012-2013
12. High viral diversity in RCCS
communities
• High viral diversity.
• Subtypes A and D predominate, both heterosexually
transmitted.
• Incidence declines in both subtypes, but rapid decline
in D.
13. Nested studies – examples and
possibilities
• Risk assessment
• Evaluation of prevention
interventions and service utilization
• Male circumcision
• Community randomized trials
• Mobility and migration analyses
• Sexual network studies
• High risk populations
• Couples analyses
• Family planning and health studies
• Demographics and household
structure
• HIV transmission dynamics
14. Multidisciplinary research: HIV
transmission dynamics in the RCCS
Background:
The extent to which continued HIV
transmission in sub-Saharan Africa is driven
by intra-community sexual networks versus
viral introductions from outside of
communities remains unknown.
Methods:
Data: RCCS (2008-2009)
46 communities, 11 geographic regions
Spatial dependence between HIV cases
(n=1,786)
14,594 participants total, HIV prevalence ~
12%
189 incident cases
>8000 geo-located households
Genetic relatedness of infecting viruses with
respect to spatial location (env, gag genes)
Transmission model
Attributable fractions from intra-household,
intra-community, and extra-community
sexual contacts (self-reported locations)
Grabowski et al., Plos Med, 20
15. Multidisciplinary research: HIV
transmission dynamics in the RCCS
Grabowski et al., Plos Med, 20
• Household transmission is common.
• Strong genetic and spatial clustering in
households.
• Transmission model: 39% (95% CI: 32-44%)
of transmissions occurred within stable
household partnerships.
• Extra-household HIV acquisition is more
common from non-stable partners outside of
the local community
• High viral diversity and weak spatial
clustering at the community scale
• 44% of incident cases clustered with
another participant in one or both
gene regions.
• 60% of incident cases that did not
cluster with a household partner,
clustered exclusively with extra-
community participants
• Transmission model: 62% (95%CI: 58-66%)
infected outside household were infected
16. Linkage of disparate community-based
HIV epidemics in Rakai
• R01 NIAID, Gates Foundation
(PANGEA-HIV)
• Timeframe: 2014-2018
• What? Elucidation of community
sexual network structures and
quantification of the extent to
which fishing communities drive
endemic HIV transmission in
Rakai, District
• How? RCCS observational data
on migration, geography of
sexual partnerships, and whole
genome HIV sequencing
• Opportunities?
– Data analysis
Ron Gray (PI), Kate Grabowski
17. Rakai Lab Studies
(Not just an HIV support laboratory)
International Collaborators:
NIH International Centers of Excellence in Research (ICER)
Thomas Quinn Lab Group (NIH/JHU)
University of Toronto
George Washington University
Karolinska Institute
18. Randomised Trials Showed Male
Circumcision Reduces HIV Infection
Rakai, Uganda
Gray et. al. (2007) Lancet; 657 – 66
Kisumu, Kenya
Bailey et. al. (2007) Lancet; 643 – 56
Orange Farm, South Africa
Auvert et. al. (2005) PLoS Med; e298
20. Male Circumcision (MC): Why the foreskin is
our window to viruses and immunology
• 3 male circumcision trials showed the foreskin
is the site of entry for 50-60% of HIV
• Serum samples, genital swabs and foreskin
tissues provide insight into virology,
immunology and the microbiome
• All studies presented today are from archived
samples to give you examples of types of
studies that can be performed with the RHSP
archive.
21. Male Circumcision Reduces
HSV-2 Acquisition
0
1
2
3
4
5
6
7
8
9
10
Overall 2+ Sexual
Partners
Inconsistent
condom use
Age 20-24
HSV-2Incidence/100py
Control
Circumcision
IRR = 0.72
(0.56-0.96)
IRR = 0.48
(0.31-0.73) IRR = 0.47
(0.30-0.73) IRR = 0.55
(0.36-0.84)
Tobian et al. NEJM 2009
22. Male Circumcision Reduces Human
Papillomavirus (HPV) Prevalence in Men
Tobian et al. NEJM 2009
0.0
10.0
20.0
30.0
40.0
50.0
60.0
High-risk
HPV
Non-high-risk
HPV
All HPV
genotypes
Multiple high-
risk HPV
Prevalence(%)
Control
Intervention
PRR = 0.65
(0.45-0.94)
PRR = 0.66
(0.49-0.91)
PRR = 0.70
(0.53-0.91)
PRR = 0.35
(0.17-0.71)
27.9
18.0
26.2
39.4
4.7
13.7
35.6
51.2
23. 0
10
20
30
40
50
60
Trichomonas BV Severe BV
Prevalence(%)
Control
Circumcision
Male Circumcision Reduces Trichomonas and
Bacterial Vaginosis in Female Partners
PRR 0.53
CI 0.33 – 0.85
PRR 0.80
CI 0.71 – 0.89
PRR 0.31
CI 0.18 – 0.54
Gray et al. Am J Ob Gyn 2009
11.2
5.9
50.6
40.3
6.5
2.0
24. 0.0
10.0
20.0
30.0
40.0
50.0
60.0
All HPV genotypes Low-risk HPV High-risk HPV
Prevalence(%)
Control
Intervention
Male Circumcision Reduces HPV
Prevalence in Women
PRR = 0.82
(0.72-0.92)
PRR = 0.77
(0.66-0.91) PRR = 0.71
(0.60-0.85)
56.5
46.1
42.5
32.9
38.6
27.5
Wawer et al. Lancet 2011
25. Biological Plausibility
CD4+
T Cells
Dendritic Cells
Tobian et al. J Infect Dis. 2013Redd et al, J Infect Dis. 2011
Foreskins from HSV-2 seropositive
men have high frequency of CD4+
T-cells present in submucosa
Foreskins from men who have
recently cleared HPV have a sig.
increase in dendritic cells
26. Liu, CM et al MBio 2013
Male Circumcision Reduces Prevalence and
Load of Genital Anaerobic BacteriaPro-inflammatory Anaerobic bacteria are
reduced by circumcision; Rakai Trial
Liu et al Mbio 2013
Species Circumcised
Prevalence %
Uncircumcised
Prevalence %
Absolute
difference (%)
Clostridia 84.4 48.1 -36
Prevotella 90.9 51.9 -39
Finegoldia 79.2 48.1 -31
Dialister 61.0 16.5 -45
Decreased pro-inflammatory anaerobes may reduce HIV target cell recruitment and
reduce HIV risk following MC
Decreased pro-inflammatory anaerobes may reduce HIV target cell recruitment and reduce
the risk of HIV following male circumcision.
30. Redd et al, JID, 2012
Diagnostic Criteria for Superinfection
Rakai, Uganda
Rate of SI (1.4/100py)
31. Available Archived Samples
• 20 years of consecutive samples among persistently
HIV-negative, HIV-positive and HIV-seroconverters
• 476,000 samples
– 162,000 genital swabs
– 314,000 sera
• Human cellular DNA
– Buffy coat
– Vaginal and penile swabs
• Largest repository of foreskins in the world
32. HIV Implementation Research
in Rakai, Uganda:
Overview & Opportunities
Larry William Chang, MD, MPH
Assistant Professor of Medicine, Epidemiology, & International Health
Johns Hopkins School of Medicine and Bloomberg School of Public Health
33. Overview
• Since 2004, RHSP has provided combination HIV prevention
(CHP) services as a PEPFAR implementer
– pre-antiretroviral therapy (ART) and ART care (with virologic
outcomes)
– prevention of mother to child HIV transmission (PMTCT)
– medical male circumcision (MMC)
– HIV counseling and testing (HCT)
– condoms and promotion of behavioral change
• 2004-2012, most services provided directly through RHSP-
run clinics.
• Currently, a hybrid, RHSP oversees all government provided
HIV services in the entire Rakai District and provides some
services directly.
34. Evaluating demand generation (stylish man) for
HIV/family planning services Rakai
• R01 NIAID
• Timeframe: 2014-2018
• What? A novel, demand creation
approach (mass media + community
mobilization) to increasing HIV service
and family planning uptake by
demedicalizing HIV prevention and
care.
• How? Community-randomized trial
• Opportunities?
– Adaptive study design
Maria Wawer (PI) et al.
35. Male Circumcision
• U01 K25 NIAID
• What? Determinants and impact of
male circumcision uptake,
circumcision device safety, task
shifting models, infant circumcision,
role of women in increasing
circumcision uptake.
• How? RCCS, Qualitative
• Opportunities?
– Mixed methods research
understanding health seeking
behaviors
– New behavioral interventions
Xiangrong Kong, Ron Gray
36. Combination HIV Prevention Evaluation
and Treatment Cascades
• Funding: Multiple sources
• Timeframe: 2000-2017
• What? Impact of combination HIV prevention on HIV
incidence, quantification of HIV service cascades over
time
• How? RCCS, time series analysis
• Opportunities
– Analytic input, economic evaluation, modeling
Everyone. Figure courtesy of Veena Billioux.
37. The PeerCARE Study: A Randomized Trial
• Timeframe: 2011-2013
• What? A randomized trial on the impact of peer support
on pre-ART outcomes (n=442).
• Results? Peers improved engagement in care,
cotrimoxazole use, and water vessel use.
• Opportunities
– Secondary data analyses
– Psychometric evaluation of
behavioral model (sIMB)
Larry Chang (PI) et al.
38. Mobile Ecological Momentary Assessment & Intervention
of Unhealthy Behaviors in Rakai, Uganda
• Center for Global Health Award
• Timeframe: 2015-2016
• What? Proof-of-concept study on whether we can use
smartphones to collect near real-time, geo-located
behavioral data (e.g. sex, smoking, alcohol).
• How? N~50, 60 days f/u, process indicators, qualitative
eval, compare to conventional survey
• Opportunities
– Similar study in other settings?
– Novel analyses?
Larry Chang (PI), Kate Grabowski (Co-Investigator/Analyst)
39. CHWs, mHealth, and Combination HIV
Prevention in a Hotspot: A Randomized Trial
• R01 (scored within funding range)
• Timeframe: 2015-2019
• What? A randomized trial on the impact of
CHWs promoting CHP supported by novel
mHealth tools.
• How? Household-level randomization in
Kasensero, a fishing community on Lake
Victoria which qualifies for Treatment as
Prevention (TasP). Primary outcomes are
CHP coverage evaluated via RCCS.
• Opportunities
– Nested studies
– Economic evaluations
Larry Chang (PI) et al.
40. Geospatial HIV Implementation Research
• Funding Source: None yet
• RHSP has collected rich geospatial data on
households, health care facilities,
community, and geographic features.
• The data can be linked to HIV
epidemiologic, service utilization, and
clinical outcomes offering the opportunity
for novel geospatially-informed HIV
implementation research.
Examples/Opportunities:
– Impact of clinic distance and travel time on virologic outcomes
of HIV-infected patients on antiretroviral therapy and on MMC
uptake
– Geospatial analyses of the appropriateness of HIV health facility
and service distribution in Rakai, Uganda
Larry Chang, Kate Grabowski
41. How to start a collaboration
• Most important: contact us to chat
• Secondary data analyses: short proposal to be
shared with US and Ugandan collaborators,
indication of funding for data set creation - if
needed.
• New RCCS module: same as above.
• New study: Discussion with US and Ugandan
colleagues on study goals and potential design;
drafted study aims; ongoing consultation.
42. Contact information
• Kate Grabowski: mgrabows@jhu.edu (cohort, transmission dynamics,
phylogentics)
• Aaron Tobian: atobian1@jhmi.edu (lab, virology, immunology)
• Larry Chang: lchang8@jhmi.edu (implementation sci, clinical)
• Maria Wawer: mwawer1@jhu.edu (a bit of everything)
• Ron Gray: rgray4@jhu.edu (a bit of everything)
• Xiangrong Kong: xkong4@jhu.edu (biostats, epi, health seeking behaviors)
• Tom Quinn: tquinn2@jhmi.edu (lab, virologiy, NIH)
• Oliver Laeyendecker: olaeyen1@jhmi.edu (lab, virology, NIH, )
• Andy Redd: aredd2@jhmi.edu (lab, immunology, NIH)
• Jessica Prodger: jessiprodger@gmail.com (immunology)
• Caitlin Kennedy: caitlinkennedy@jhu.edu (qualitative research)
• Ned Sacktor: sacktor@jhmi.edu (neuro-HIV epidemiology)
• Nandy Pilgrim npilgrim@popcouncil.org (social science, adolescents)
• Lilian Mutesi (Admin): lmutesi1@jhu.edu