Embracing My Role as a Researcher – Sharing My Small Slice of the HPV Research Pie

Embracing My Role as a Researcher – Sharing My Small Slice of the HPV Research Pie

Guest Blog: Carissa Novak Throughout my recently completely Masters in Global Health Science, Duke’s Global Health Institute faculty regularly stressed the importance and potential impact of disseminating research findings. Therefore, I felt presenting the research findings from my thesis at the 32nd International Papillomavirus Conference in Sydney, Australia, this fall was not only appropriate but necessary. Due to ongoing conversations regarding HPV vaccination coverage and HPV screening for cervical cancer communities are witnessing a tremendous increase in screening rates, especially in low-resource settings, where cervical cancer is most common. However, most programs still face significant challenges in addressing HPV positive women’s low rates of follow-up and treatment. My attendance at the conference was an opportunity to share the findings of my thesis work, in which we found that in western Kenya, a setting where resources were limited for all HPV positive women, stigma and isolation were the main differentiating feature between women who accessed follow-up and those who did not. Interestingly, I presented...
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Partner Updates: Uganda

Partner Updates: Uganda

Our Ugandan colleagues at the Makerere College of Health Sciences have been busy over the past few months. Center members’ work has focused on various aspects of cervical cancer, from prevention to diagnosis and treatment. Dr. Miriam Nakalembe is still leading the NCI-funded effort to evaluate community-based strategies for cervical cancer detection, in partnership with Dr. Megan Huchko. Building on this work, she is a co-investigator on a recently funded two-year project through the Fogarty International Center. The grant seeks to develop a portable imaging technique, called a smartphone confocal endoscope. The new technology would visualize cellular details of human cervix in vivo without taking a biopsy, and after validation would be adapted to provide a low-cost diagnostic tool for other diseases in both resource poor and resource rich settings. Dr. Jane Namugga continues her work with Dr. Paula Lee. The pair have completed data collection for a project to determine rates of completion and adverse events associated with receiving chemotherapy...
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Director’s Blog: Fall 2018

A month into the start of the new school year is a good time to reflect on the value the Center can bring to an academic setting like Duke. More salient is the recognition of the value that students and learners bring to Center. This is my third semester teaching Global Sexual and Reproductive Health, one of the core Center courses. The undergraduates continue to impress me with the experience and passion they bring to the classroom, to their research assignments and to their lives in the Duke community. Every year, I learn new things and gain new perspective from the discussions and viewpoints in brought forth in the course. This year, I’m leading two additional student research initiatives in which I already recognize that I’ll learn much more than I will teach the students. I have been working with students through the Big Data for Reproductive Health project since May, when Amy Finnegan and I helped manage a Data Plus...
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Teammate Spotlight: Sandra Oketch

Sandra Yvonne Oketch has been working with Dr. Megan Huchko and the FACES team the Nyanza Region of western Kenya for the past ten years. She has 10 years’ work experience in both health research and program set up in maternal reproductive health and HIV/ AIDS care and prevention. She started as a Clinical and Community Health Advisor at FACES, where she became interested in the cervical cancer screening and prevention program. After going back to school to complete her degree, she is now the study coordinator of a cluster randomized trial testing two implementation strategies for HPV testing. Her roles include managing the study team, partnering with the reproductive health team to implement study activities and evaluating some of the study data. The work of enrolling and following up almost ten thousand women is not without challenges. In addition to the inherent challenges of coordinating a study that size, Oketch has had to deal with flooding, flyaway tents, political...
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Health Systems Barriers to Cervical Cancer Prevention in Kenya

Health Systems Barriers to Cervical Cancer Prevention in Kenya

Blog by Charlotte Page, Ob/Gyn Resident: This is a follow-up post to “Patient Barriers to Cervical Cancer Prevention in Kenya”. I’ve realized while in Kenya that there are a lot of things I take for granted in bathrooms in the US: running water, a toilet that flushes, toilet paper, soap, and electricity. If you’re missing one of these things, the restroom is that much more uncomfortable – or perhaps even unfunctional. Similarly, small systems issues here in Kenya can inhibit women from receiving the healthcare they need. For the HPV-positive women in the study I’m working on, such problems can significantly increase the amount of time and effort required to get treated with cryotherapy, to the point that some women don’t obtain treatment at all. To paint a picture: yesterday I was at Migori County Referral Hospital (MCRH), one of the sites where cryotherapy is provided in our study. This procedure uses compressed gas to freeze precancerous cells on the cervix, thereby preventing them...
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CDC Report Finds Increased Risk of Birth Defects and Developmental Problems in Infants Born to Zika-Exposed Mothers

CDC Report Finds Increased Risk of Birth Defects and Developmental Problems in Infants Born to Zika-Exposed Mothers

The world’s public health experts have been actively addressing the Zika crisis since it was discovered two years ago. Travel warnings, diagnostics testing, pregnancy guidelines and vector control have prevented substantial numbers of infants born with the devastating impacts of microcephaly. The CDC followed up 1450 US children born to mothers who had suspected or confirmed Zika, and released the findings from their one year follow-up. In addition to microcephaly, the infants had an increased rate of birth defects and neurodevelopmental delays. The study also found that the majority of children had not undergone neuroimaging or an eye examination, leading to missed opportunities to detect and possibly address problems at an early age. The authors recommended increased screening among pediatric providers and referral to specialists for children of zika-exposed mothers. The CDC will continue to follow these infants, and is currently following up a Brazilian cohort through the ZODIAC study. As we await the results of these longer-term studies, these...
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Gaining Insight into Kenyan Community Health

Gaining Insight into Kenyan Community Health

Blog by Amber Fleck, MS2, University of Colorado: In the United States, health education is seemingly everywhere: ads online reminding women of the importance of pap smears, TV commercials advising against smoking, or posters in bar bathrooms providing safe sex advice. With this abundance of exposure to health education, it is a striking difference to visit a country where many communities don’t have regular access to this kind of information, especially if that information regards sexual or reproductive health. In an effort to bridge this gap and enhance community health education the Kenya Ministry of Health began using lay workers, also known as community health volunteers (CHVs). CHVs travel door-to-door in their assigned communities to educate individuals about disease management, including reproductive and maternal health, and provide referrals to the clinic when necessary. In theory, this is an excellent way to increase access to health information and care; however, these programs have had some significant challenges. One challenge is that these are...
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Data+ Team Introduces Novel Visualization Methods to Understand Contraceptive Trends

Data+ Team Introduces Novel Visualization Methods to Understand Contraceptive Trends

Saumya Sao (T ’20, Gender, Feminist and Sexuality; Global Health) and Melanie Lai Wei (Masters’ Candidate, Statistical Science) were proud to share the results of their 10-week Data+ project, Big Data for Reproductive Health, or BD4RH. The pair was just one of 25 teams that spent the summer using data-driven approaches to solve interdisciplinary challenges. The BD4RH team, led by Amy Finnegan and Megan Huchko, sought to build a web-based application that will allow users to visualize and analyze contraceptive calendar data from the DHS. To ground their project, they did a mapping exercise to identify currently available tools, identifying core elements they liked and key areas a new tool could improve. Using this data, and user feedback from various stakeholders in the field, they created a website that hosts four different data visualization methods to interpret trends in contraceptive use from the DHS contraceptive calendar. The site currently uses Kenya data to demonstrate efficacy, but datasets will be added...
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Legislation Promoting HPV Vaccine Use Does NOT Increase Risky Sexual Behavior

Legislation Promoting HPV Vaccine Use Does NOT Increase Risky Sexual Behavior

  The relatively low HPV vaccine uptake in the US has been attributed in part to fears that vaccinating against the sexually transmitted virus would encourage early or risky sexual behavior in adolescents. To look at the potential impact of pro-vaccine legislation on behaviors, researchers compared CDC surveillance data on teen sexual activity in states in the US with policies promoting or mandating HPV vaccination among adolescents to states without any specific vaccination policies in a study published in Pediatrics this month. They found no difference in reported sexual activity or risk behavior in states with vaccine legislation. These results support a prior study in which researchers looked at diagnosis of sexually transmitted infection as a marker for sexual activity or increased risk behavior, and found that there was no difference between vaccinated and unvaccinated adolescents over the five year study period. Despite this consistent, reassuring evidence that vaccinating for HPV will not increase sexual activity among adolescents, the US has...
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Multi-Lateral Call to Action to Attain Universal Health Coverage through Sexual and Reproductive Health and Rights that include HIV linkages

Multi-Lateral Call to Action to Attain Universal Health Coverage through Sexual and Reproductive Health and Rights that include HIV linkages

Despite the many interconnected risk factors and affected populations, the integration of HIV prevention and treatment services and sexual and reproductive health and rights has not been straightforward. Recently, there has been an increase in the calls for integration from some important global health group. A recent Comment in the Lancet responded to the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR) report, which highlighted the need for universal access to integrated SRHR packages, including HIV prevention and treatment. The authors set out three main strategies to improve this: 1) Empower women at the individual and community level, 2) Secure accountable leadership, governance and financing from government and international agencies and 3) Improve the coordination and cooperation across various sectors. This was followed by a more specific call to action launched at AIDS 2018. More than 35 international agencies signed on to these 10 key actions necessary to advance both SRHR and HIV treatment, prevention and care. The...
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