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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Director’s Blog: Summer 2018

Director’s Blog: Summer 2018

As we close out the academic year and head into the hot North Carolina summer, the halls of Trent get a lot quieter. To some, this calm may suggest a mass exodus to the beach or some other vacation destination. However, for faculty, students and staff, the empty offices belie a frenzy of work, as many head off to field sites around the world. Summer break represents a time to re-focus on the work that inspires students, trainees and faculty to put in the hours teaching, writing and learning throughout the year. We use this time to launch new projects, reconnect with their research teams and develop or deepen our partnerships. As we previously described, we have a very busy summer planned with work and site visits in western Kenya, while back at home, continuing with the launch of the Collaboratory project and the Big Data for Reproductive Health Summer team. I spent the last two weeks in June in Nairobi,...
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RTI team provides key advice to Duke Big Data for Reproductive Health Team

RTI team provides key advice to Duke Big Data for Reproductive Health Team

On Monday afternoon, the Big Data for Reproductive Health Data+ Team met with Alex Pavluck and Alison Mitchell LeFew from RTI to describe their project and get direction in how to develop a “minimally viable product.” The meeting represents one of the first educational engagements of the Duke-RTI Collaboration. The goal for the 10-week Data+ project is to build a web-based application that will allow users to visualize and analyze contraceptive calendar data from the DHS. Students presented their research on currently available tools, identifying core elements they liked and key areas a new tool could improve. Pavluck, a senior manager for information and communication development for the Global Health Division of the International Development Group at RTI, shared his experience and provided advice on how to develop an MVP for user testing. The active discussion ranged from big picture needs to the technical details necessary to move the project forward. The meeting was a great example of key stakeholder...
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New studies show HPV screening is less expensive and more efficient when offered at community health campaigns compared to health clinics in rural Kenya

New studies show HPV screening is less expensive and more efficient when offered at community health campaigns compared to health clinics in rural Kenya

Cost concerns now dominate considerations for the expanded use of HPV screening for cervical cancer prevention in high and low-resource settings. As part of a trial comparing two implementation strategies for HPV testing offered via self-collection, our team recently published innovative analyses of the material and time costs for each strategy. In the larger trial, the team showed that HPV-screening through community-health campaigns (CHCs) reached more women than testing in government-supported health facilities. These new papers show that HPV-screening through CHCs was also lower in cost and provided a quicker and more efficient experience for women compared to offering HPV screening at health clinics in rural Kenya. The next step is a cost-effectiveness analysis to compare alternative screening and treatment strategies using primary data from this study along with, published data to determine the cost per disability-adjusted life year (DALY). These results can be used to help policy-makers and funders make key decisions about how to implement cervical cancer prevention...
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