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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Family Planning Use in East Africa

Family Planning Use in East Africa

Family planning (FP) is critical in the promotion of community health. It is an intervention that is proven to save lives and foster development. Research supports the notion that family planning is directly linked to improvement in maternal and child health in addition to socio-economic progress. Understanding the unmet need for family planning services is key to improving worldwide reproductive health. During the last three decades in East Africa, research shows that Kenya and Rwanda are clear leaders in regards to access to and use of contraception. These two countries have a history of implementing targeted and focused programs to improve access to FP services. FP differs in each country in ways such as the amount of methods offered and the extent to which each method is available. Across the sub-region there is an increase in the use of modern contraceptives. But, a steady proportion of women in Ethiopia, Rwanda, and Tanzania are still using traditional methods. While short-term contraception is frequent in the sub-region, there is...
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WORLD CONTRACEPTION DAY CELEBRATION AT KISUMU COUNTY

WORLD CONTRACEPTION DAY CELEBRATION AT KISUMU COUNTY

World Contraception Day annually takes place on September 26th. The worldwide campaign is centered on a vision where every pregnancy is planned and wanted. This year, Kisumu County joined the rest of the world in celebration at the Simba Opepo Dispensary. County officials and over 10 partners attended, with Deputy Governor Dr. Mathews Owino as the chief guest; he expressed commitment to the county leadership and its growth. The community came together to promote and echo important actions on Family Planning (FP) and contraceptives, improve awareness on contraception, and enable young people to make informed reproductive health choices. Healthcare workers were encouraged to support clients in selecting appropriate FP methods and discussing possible side effects. There is a need in the community for counseling on correct methods and their associated potential warning signs. Further, the celebration called for the mentoring of healthcare workers in order for them to have the right attitude towards youths. This attitude will allow patients to freely walk into...
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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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Notes from the Field: Equipping Kenya County Health Facilities Remains a Challenge

Notes from the Field: Equipping Kenya County Health Facilities Remains a Challenge

Cryotherapy is a method used to destroy precancerous cells to keep them from turning into cancer later on. According to medical experts, early detection and treatment of cervical cancer has demonstrated to dramatically improve the chances of survival. This is good news, as cervical cancer remains the most prevalent form of cancer in women in many developing countries, Kenya included and worst more to HIV+ women who are more likely to suffer from this type of cancer due to compromised immunity. There have been concerted efforts by both the Kenyan government and the private sector to raise awareness and scale up screening and treatment services across the country, which has led to a steady rise and improvement in treatment facilities. The ability of a patient to attend a screening clinic and to return to clinic follow-up evaluation and possible treatment is an important component to the success of a screening program.  Once she surpasses the myriad barriers she may face in understanding...
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Notes from the Field: “If only I stepped up to the gate of a school” life could have been better

Reproductive health remains a health problem in Sub-Saharan Africa, Kenya included. Unless efforts to reduce maternal and newborn mortality and morbidity, improving access to family planning, and preventing HIV infection are scaled up, the majority of Kenyans remain at risk for poor health outcomes. Women face unsafe abortions, early marriage, and various forms of gender-based violence. They suffer silently from sexually transmitted diseases that make them vulnerable to cervical cancer and infertility, without access to the simple preventive measures like screening and vaccination. My experience working directly in the community and in health facilities has given me the opportunity to interact with various partners and many disadvantaged young men and women. Listening to their stories of teenage pregnancy, their beliefs in myths related to use of contraception, and experiences with HIV has made me keen to understand and try to address issues related to reproductive health. I met "Aisha" (not her real name) when her child was enrolled in a study I...
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Reports from the Field: Freedom House, a Safe Space supported by KMET

Reports from the Field: Freedom House, a Safe Space supported by KMET

By Faith Otewa: One of our goals of the Center is to highlight some of the important work in Sexual and Reproductive Health taking place in Kisumu and Nyanza. We were thrilled to sit down with the Director of KMET (Kisumu Medical and Education Trust), a Kisumu-based NGO working to promote innovative and sustainable reproductive health and education programs among underserved communities. KMET works in the areas of Maternal, Child, Adolescent and Child Health, livelihoods and nutrition, education and youth/adolescent empowerment and quality healthcare financing. The organization has adopted an integrated model to provide a holistic care to women by offering specialized diagnostic services like Family Planning Services (FP), Immunization, and HIV Testing, Cervical Cancer Screening and Laboratory services. A well-stocked dispensing pharmacy is also in place. KMET also houses a Youth Friendly Clinic for its youthful clients of reproductive age. The services offered at the center are affordable. With growing evidence that a substantial number of girls, children and women in Kisumu...
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All in a Day’s Work: Engaging the Community through HPV testing in Kisumu

All in a Day’s Work: Engaging the Community through HPV testing in Kisumu

Blog by Faith Otewa In my role as site coordinator of the Kisumu Center office, I’ve had the opportunity to oversee the “Hybrid Study,” in which we are looking at integrating HPV testing into community health campaigns providing multiple other disease services, including HIV testing, family planning and TB testing.  Many of the experiences will linger on with us for many years to come; while some illustrate the challenges encountered in conducting research and community-based care in Africa, others show the power of community mobilization and knowledge. It is the 10th week out in the field and the study team are getting ready to recruit at the 3rd set of campaigns. However, as if often the case in western Kenya, and certainly when we are working in tents set out in the middle of fields, the climate has had a big impact on study.  The harsh weather and copious rainstorms experienced in the month of May this vastly affected recruitment. There has...
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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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