Nominated From: University of Louisville
Research Site: Kenya
Research Area: Public Health
Primary Mentor: Alison Drake
Evaluation of Health Strategies to Optimize Adherence and Efficacy of PMTCT/ART
With support from a Fulbright-Fogarty Scholarship, I propose to conduct public health research in collaboration with the Kenya Medical Research Institute in Nairobi and the Kenya Research Program at the University of Washington. I will be working under primary investigator Dr. Alison Drake and will focus on Prevention of Mother-to-Child HIV transmission at the Kenya Medical Research Institute in Nairobi. This research facility is also associated with the Kenyatta National Hospital, University of Nairobi’s academic teaching hospital.
My undergraduate research background, medical clinical training, participation in a MD Distinction in Global Health, and current medical thesis development on maternal-child health in rural Tanzania make me a candidate uniquely primed to conduct public health research on an international level. My training experiences will culminate with a Fulbright-Fogarty Scholarship in Kenya.
A medical school distinction track provides a secondary focus of learning, concluding in a research thesis. The Distinction in Global Health at UL School of Medicine offers engaging lectures on public health topics, bi-monthly journal club participation, critical reflections, service opportunities, research support, and online modules that teach topics not emphasized in the traditional curriculum and serve as learning opportunities above and beyond the normal course load of medical school. Through the Distinction in Global Health, I have begun work on a thesis exploring birthing practices in Mufindi, Tanzania. My MD thesis came about because of a summer medical service trip following my first year in medical school. This region in Tanzania is known as a pocket with a high HIV prevalence at triple the national rate and I saw firsthand the devastation this illness causes. Women of childbearing years are particularly susceptible to HIV with a rate twice that in men. All of these healthcare needs, along with my interest in obstetrics/gynecology, prompted research in Kenya.
Awareness of HIV transmission and prevention is largely due to campaigns in the 1990s. As a result, today most people have heard of HIV, how it leads to AIDS, and that it is spread by bodily fluids. Despite this knowledge, HIV prevalence in Kenya was 5.3% of the adult population in 2012. This is contrasted drastically with a US prevalence of 0.4- 0.9% of the adult population in the same year. The advent of anti-retroviral therapy (ART) in the mid-1990s helped increase lifespan and delay progression to AIDS in millions of patients. Prevention of Mother-to-Child Transmission (PMTCT) is a key issue utilizing antiretroviral therapy targeted by both the World Health Organization (WHO) and Kenyan government. Guidelines set by WHO in 2013 advocate HIV testing to all pregnant women and lifelong adherence to ART regardless of viral load. In Kenya, HIV positive women comprised 6.9% of females while HIV positive men comprised 4.2% of males. These statistics highlight the importance of PMTCT aims by the WHO. The guidelines are most easily achieved when women attend prenatal health appointments as women who do not seek appointments or experience significant barriers to healthcare miss opportunities for HIV testing and medication checks.
The project entitled, “Evaluation of mHealth Strategies to Optimize Adherence and Efficacy of PMTCT/ART” analyses if text messaging (SMS) increases ART adherence and prenatal healthcare visits in pregnant women. There will be three arms to this clinical study: one group of women who will receive personalized but pre-formulated text messages (1-way SMS), one group of women who will receive personalized text messages with the option of response and reply by a healthcare professional (2-way SMS), and one group of women who receive no text messages (control). The principal investigator leading this project, Dr. Alison Drake, has established collaborations with local phone service companies to provide free text messages related to the project for all women enrolled in the study.
My participation in the project will enable me to learn more about mother-to-child HIV transmission, its prevention, barriers to medication adherence, and the process of conducting a clinical trial in an international setting. All of these new skills will assist me in delivering quality medical care to HIV+ mothers in my future practice. I have established three primary aims for my involvement in this study:
(1) Reviewing medical records of enrolled patients to ensure SMS messages are personalized and accurate. This will comprise the bulk of my first few months conducting research.
(2) Responding to women in the 2-way SMS arm when they are comfortable with exchanges in English and helping to book prenatal appointments in both test arms.
(3) Comparing the 1-way SMS group with the 2-way SMS group and the control group. Factors assessed are number of prenatal healthcare appointments attended, number of women successfully completing the study in each arm, number of women who drop out, and HIV transmission rates in infants born to enrolled mothers.