Mina Hosseinipour Dedicates Career to Eradicating Health and Educational Disparities in Malawi

Mina Hosseinipour, MD, MPH, second from right, with her colleagues at UNC Project-Malawi.

Mina Hosseinipour, MD, MPH, second from right, with her colleagues at UNC Project-Malawi.

Mina Hosseinipour, MD, MPH, thinks outside the box when it comes to ensuring the medical professionals that train at UNC Project-Malawi receive the education needed to be successful clinicians and researchers. She received her medical and public health degrees in the United States, but has served the citizens of Malawi for 14 years as a clinician, researcher and educator through a collaboration between UNC, the Malawi Ministry of Health and the Malawi College of Medicine. She recently received notice of an award for a National Institutes of Health (NIH) D43 Fogarty International Research Training grant that will fund training and research activities to ensure that Malawian investigators are capable of conducting the research that can assist them to tackle the most relevant HIV questions in their clinical setting.

“When I ask junior faculty about their long term goals, they will often state that they want to be an independent investigator,” says Hosseinipour, who serves as UNC Project-Malawi’s Scientific Director and a Research Professor of Medicine at UNC. “But often, they don’t really have an understanding of the requirements to reach independence because they haven’t had mentors along the way.”

Malawi, a country in Sub-Saharan Africa, has a population of 16 million and 11 percent of adults are living with HIV. The training grant Hosseinipour secured will provide $1.5 million of direct funding for five years and will build off of UNC Project-Malawi’s 15-year partnership with Fogarty-sponsored trainings that have developed an ever-growing pool of Malawian researchers. The program will be called the Malawi HIV Implementation Research Training Program (M-HIRST). Hosseinipour says the goal of this award is to train a total of 170 people – 12 junior faculty to participate in the Research Faculty Mentorship Program, two doctoral students, six master’s degree candidates and more than 150 participants in short course programs about implementation science, clinical trial design, statistics and scientific writing.

“In a resource-limited setting, the best strategies to implement programs are of critical importance so that available resources can be utilized more effectively,” Hosseinipour says. “This grant will allow Malawians to benefit from best practices in HIV care and treatment. And if our faculty development program is successful, other countries and other medical schools may use our program as a model for investing in the development of research scientists.”

Innocent Mofolo, MSc, is the Associate Country Director and Administrative Manager of UNC Project-Malawi. He says Hosseinipour’s contribution to the health care system in Malawi is immeasurable.

“Over the years, she has contributed to the development of young scientist and clinicians. Some of them have now risen and have taken leadership positions in government influencing policy,” Mofolo says. “Mina has indeed contributed to eradicate health disparities and her commitment to training the next generation of Malawian clinicians and researchers has been a great contribution to the country. She has mentored many Malawian scientist and clinicians who are now leaders and are also training others. She is committed to Malawi and continues to train and mentor young scientist and doctors. I cannot say enough how her service to Malawi is invaluable.”

Medical Residency Inspires Global View of Health

Mina Hosseinipour, MD, MPH, front left,  and her colleagues at UNC Project-Malawi organized an after-work fitness group that plays volleyball and football.

Mina Hosseinipour, MD, MPH, front left, and her colleagues at UNC Project-Malawi take care of their own health through an after-work fitness group.

Improving the health of people living with HIV first touched Hosseinipour in the late 1990s when she was completing her residency in infectious diseases at Baylor College of Medicine in Houston.

“This was just as combination antiretroviral therapy (ART) for HIV was introduced and the transformation in HIV care was dramatic,” Hosseinipour says. “Also, since I was training in Houston, there were large numbers of immigrants with tropical infectious diseases that I found interesting. Broadly, both of theses conditions highlighted health disparities between resource-rich and poor settings that I thought I could address through further training in public health and infectious diseases.”

With her sights set on improving public health at a global level, Hosseinipour found her ideal training program through UNC’s Infectious Diseases Fellowship and the Gillings School of Global Public Health’s MPH degree. During her fellowship, she had the opportunity to train at UNC Project-Malawi. Watching Malawians living with HIV struggle to afford their antiretroviral therapy inspired Hosseinipour to act.

“When I arrived in Malawi, there was only a single combination tablet that was available and the cost was $35 a month. While this sounds like a small amount, in one of the poorest countries in the world, this was inaccessible to most,” she says. “Those who tried to start treatment at this price often dropped out of care. I became part of the task force to develop treatment guidelines for Malawi and it was clear that there needed to be a free program. With funding from the Global Fund, the Malawi ART Program launched a free medications program in 2004. My participation in the roll-out of ART in Malawi has been one of my most rewarding experiences.”

Irving Hoffman, PA, MPH, is the International Director of UNC-Project Malawi. He says Hosseinipour’s passion to eradicate health disparities and her commitment to training the next generation of Malawian clinicians and researchers is commendable.

“What Mina has accomplished during her life in Malawi has been nothing short of heroic,” says Hoffman. “Her commitment to preventing and treating HIV has singlehandedly saved thousands of lives. Just as importantly, her fierce commitment to the training of Malawian clinicians and scientists will have an enduring effect on improving the health of all Malawians for years to come. Mina is a brilliant scientist and clinician, and she has sacrificed a lot to stay in Malawi all these years and continue her good work. The UNC family is indebted to her for her significant service.”

During her 14 years at UNC Project-Malawi, Hosseinipour has seen her role evolve from an infectious diseases trainee to the Scientific Director of the site. She says her varying duties at the site – administrator, clinician, researcher and educator – keep the work challenging and rewarding.

“I am involved in clinical care, the education of undergraduates to junior faculty, a broad range of research projects in HIV treatment and prevention, and I participate in national policy discussions,” Hosseinipour says. “The variety of activities in which I get to participate means there is never a dull moment. Even if one component is not going well, I can be sure that something is succeeding.”

And she also knows how to have fun. Hosseinipour leads UNC Project-Malawi’s after-work fitness volleyball and football teams as well as manages the Lilongwe ultimate Frisbee club.

The UNC Project-Malawi staff also have volleyball and football (soccer) teams that Mina Hosseinipour leads. UNC's Institute for Global Health & Infectious Diseases Director Myron Cohen, MD, seventh from right, participates when he is in Lilongwe.

The UNC Project-Malawi staff also have volleyball and football (soccer) teams that Mina Hosseinipour leads. UNC’s Institute for Global Health & Infectious Diseases Director Myron Cohen, MD, seventh from right, participates when he is in Lilongwe.

Blog: Semester Abroad Allows UNC Junior to Launch Social Media Health Campaigns in London

Ben Lineberger is a junior at UNC majoring in journalism and public relations. He is also a web consultant for UNC’s IGHID. This past fall semester, Ben studied in London and interned with National AIDS Trust or NAT. NAT is the United Kingdom’s leading charity dedicated to transforming society’s response to HIV through fresh thinking, expertise and practical resources. Ben spent the semester working with NAT on a number of educational campaigns, including having a kissing Booth in Soho Square on Dec. 1 for World AIDS Day in response to NAT research that shows 16 percent of people wrongly think you can get HIV from kissing, up from 4 percent 10 years ago. Below, Ben shares his thoughts on how far the UK has come in HIV prevention and treatment and where it still needs to focus.

During my time interning at NAT (National AIDS Trust) in London, I’ve learned so much about the whole HIV sector and seen a glimpse of what it’s like to live with HIV. I’ve been the communications intern at NAT this past semester and the whole experience has taught me more than I ever expected. I’ve not only gotten to do more for an organization in just a few months than I have in any previous internship, but as an intern I’ve participated in meetings with top ad and PR agencies, helped build a campaign, and performed research that’s informed our press releases and blogs. But what I’ve been most surprised by is how wrapped up in the fight against HIV and HIV stigma I’ve become. Here’s a bit about what I’ve learned about HIV in the UK:

UNC Journalism and Public Relations Major Ben Lineberger, third from right, with NAT staff and volunteers at a fundraising event on Bonfire Night in London.

UNC Journalism and Public Relations Major Ben Lineberger, third from right, with NAT staff and volunteers at a fundraising event on Bonfire Night in London.

Quality of life with HIV in the UK has seen marginal improvements in the past few years. Though it’s come quite a ways from the 1980s and 90s, there’s still a lot of work to do in terms of making life better for people living with HIV. In regards to social climate and public attitude toward HIV, though there have been recent improvements in policies concerning healthcare workers with HIV, a stigma still exists that makes it hard for folks to be open about their status. People face misunderstanding about their status, with a lot of people still thinking they can get it from kissing or sharing food. In addition, only recently have healthcare workers with HIV been able to perform exposure-prone procedures provided they’re on treatment. This policy is actually safer for patients, as undiagnosed HIV is actually more dangerous than when someone knows they have it and are on treatment. Discrimination, both overt and subtle, minimizes HIV as a serious issue and makes it difficult for people to get the facts about transmission and sexual health. This contributes to the growing problem of late diagnoses, as last year saw 40 percent of adults diagnosed at a late stage, after treatment should have begun. And with 72 percent of new diagnoses last year being among gay and bisexual men and black African heterosexuals, it’s evident that both prevention and testing efforts must be ramped up in the UK.

Clinically, more efforts must be made to strengthen prevention measures. PrEP, which stands for pre-exposure prophylaxis, has been found to almost always be effective at preventing uninfected individuals from contracting HIV if taken correctly. But in the UK, it’s unavailable on the National Health Service (NHS), which means almost no one can get it unless they have enough money to order it from overseas. Though treatment for those who already have HIV is made widely available in the form of ART (antiretroviral therapy), there is still a serious problem with the way HIV prevention care is managed, as the NHS is essentially failing those most at risk of contraction.

Another side of the issue with HIV care in the UK is lack of knowledge, stemming not only from discrimination in society, but also from the way sexual health is taught in UK schools. The curriculum for sex and relationship education, or SRE, doesn’t include any compulsory lessons on same-sex relationships. This means young people who identify as anything other than heterosexual aren’t getting vital, reliable information about their bodies and sexual health, which is leading to ignorance surrounding HIV, not to mention other risks that come from sex. This is another type of prevention that the UK is failing to ensure is working properly, and can only be corrected if SRE is free from discrimination as well.

Ben participating in the social media component of NAT's World AIDS Day campaign #RethinkHIV by painting a red ribbon on his lips.

Ben participating in the social media component of NAT’s World AIDS Day campaign #RethinkHIV by painting a red ribbon on his lips.

Not all is going badly, however, as there are many HIV-related successes. The UK is world-leading on treatment, as anyone living with HIV can access ART for free on the NHS, meaning that there’s an extremely low death rate from HIV and people can manage their health and have full life expectancies. ART can also help people achieve undetectable viral loads, which enables them to have sex with their partner without risk, and to reproduce without risk of passing it on to their children as well. Additionally, as the population of people living with HIV is aging – one in four are over 50 – NAT has developed new guidance for healthcare workers. Unfortunately, some parts of the health care sector don’t have up-to-date information on HIV and how it’s transmitted, which can lead to discrimination and insensitive treatment for the aging population. The new guidelines advise on how to be receptive and judgement-free, as well as maintaining confidentiality. There have been a great number of improvements, but much more has to happen before people living with HIV have the best quality of life possible.

My experience at NAT has been especially educational because I’ve gotten to work alongside a brilliant policy team that helped the communications team be fully informed for all the decisions leading up to our campaign. Being updated on all the policy related to HIV has elevated my knowledge on the subject and helped me really understand all sides of the issue. I didn’t expect to be so moved by all the negative things said about people living with HIV, but once I realized how harmful the stigma still is I became really invested in fighting it. I’m lucky that I’ve gotten to be a part of a team that’s so focused on combatting unfair and uninformed stigma and discrimination, and I’m grateful that each part of the internship has taught me something. And though there are still faults in the UK’s policies and attitudes regarding HIV, London has been an amazing place to live and study for a semester and I’m really happy I got to be here.

World AIDS Day 2015: UNC Faculty Move HIV Research & Clinical Care Forward

Tuesday, Dec. 1, marks World AIDS Day. UNC Institute for Global Health & Infectious Diseases faculty are proud of the many research studies they have led or participated in this year that have prevented further infections, and improved treatment for the more than 30 million people living with HIV worldwide. Below is a snapshot of the work we have completed in 2015 to move the world closer toward an AIDS-free generation.

Early HIV Treatment Provides Protection for Uninfected Partner

Myron Cohen, MD

Myron Cohen, MD

Antiretroviral therapy (ART) for HIV infection provides lasting protection against the sexual transmission of the virus from infected men and women to their HIV-uninfected sexual partners, investigators from the University of North Carolina at Chapel Hill and the HIV Prevention Trials Network (HPTN) reported Monday, July 20, at the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment & Prevention in Vancouver, Canada.

The study, known as HPTN 052, began in 2005 and enrolled 1,763 HIV sero-discordant couples – where one person is HIV-infected and the other is not – at 13 sites in nine countries. The majority of the couples were heterosexual (97 percent). HIV-infected partners were assigned to start ART at the beginning of the study, called the “early” arm, or later in the study, called the “delayed” arm. Those on the delayed arm started ART when their bodies’ immune systems were declining. HPTN 052 was funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH).

“These findings demonstrate that antiretroviral therapy, when taken until viral suppression is achieved and sustained, is a highly effective, durable intervention for HIV prevention,” said Myron Cohen, MD, Director of UNC’s Institute for Global Health and Infectious Diseases, and Principal Investigator for HPTN 052. “The HPTN 052 trial was designed to address two questions: whether providing antiretroviral therapy to an HIV-infected person would prevent HIV transmission to a sexual partner, and whether earlier antiretroviral therapy offered long-lasting health benefits, and the answer to both is a
resounding yes.”

In 2011, an interim review of the study data showed a 96 percent reduction of HIV transmission within the couples assigned to early ART, which was considered a major breakthrough finding. After the release of the results, all participants in the delayed ART arm were offered the opportunity to begin ART, and the study continued for four more years. By the end of the study, 1,171 couples remained in follow-up.

The final results show a sustained 93 percent reduction of HIV transmission within couples when the HIV-infected partner was taking ART as prescribed and viral load was suppressed. Notably, there were only 8 cases of HIV transmission within couples after the HIV-infected partner was given ART. However, four of these eight cases were diagnosed soon after ART initiation and transmission likely occurred before the HIV infected partner was virally suppressed. The other four were diagnosed when the HIV-infected partner had detectable levels of virus in the blood despite being on ART (treatment failure). Treatment failure may have occurred because participants either did not take their antiretroviral drugs as prescribed or had an HIV strain that resisted or acquired resistance to one or more of the drugs in their treatment regimen.

HPTN 052 investigators are also reporting findings at the IAS conference concerning the relationship between viral load, viral suppression, treatment failure and drug resistance. Investigators found that having a relatively high level of HIV in the blood at the start of treatment was associated with a longer time to viral suppression, which, in turn, was associated with both treatment failure and a shorter time to treatment failure. In addition, the investigators found, among the HPTN 052 participants who failed treatment, those who had a higher viral load when they joined the study were more likely to develop resistance to their antiretroviral drugs. More research is needed to understand this association, according to the investigators.

“These results have important implications for programs seeking to combine other HIV prevention measures with treatment as prevention,” Cohen says. “In the setting of such programs, special efforts should be made to minimize HIV transmission risk before viral suppression has been achieved, to maintain suppression on ART, and to identify and address ART failure.”

UNC and GSK Announce Novel Partnership to Accelerate Search for HIV Cure

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The University of North Carolina at Chapel Hill, a leading global public research university with significant expertise in HIV basic and clinical research, and GSK, a global, research-based pharmaceutical and healthcare company with a legacy of success in developing treatments for HIV, announced the creation of the dedicated HIV Cure center and a jointly owned new company that will focus on discovering a cure for HIV/AIDS. This unique public-private partnership will redefine the traditional way of conducting research and create a new model to seek the breakthroughs needed to tackle an extraordinarily challenging global health issue.

The HIV Cure center will be located on the UNC-Chapel Hill campus and will focus exclusively on finding a cure for HIV/AIDS. The new company, Qura Therapeutics, will handle the business side of the partnership, including intellectual property, commercialization, manufacturing and governance. Together, the HIV Cure center and Qura Therapeutics will serve as a catalyst for additional partners and public funding that will likely be needed to eradicate HIV worldwide. The collaboration is also expected to recruit and attract top talent from around the world.

“The excitement of this public-private partnership lies in its vast potential,” said UNC-Chapel Hill Chancellor Carol L. Folt. “Carolina has been at the forefront of HIV/AIDS research for the last 30 years. This first of its kind, joint-ownership model is a novel approach toward finding a cure, and we hope it serves as an invitation to the world’s best researchers and scientists. Today, Carolina’s best are taking another major step in the global fight against HIV/AIDS.”

“Like UNC, GSK has a long legacy of HIV research success. From the development of the world’s first breakthrough medicine for HIV patients in the 1980s, to our leadership in the market today through ViiV Healthcare, we’re continuously challenging ourselves to meet the needs of patients,” GSK CEO Sir Andrew Witty said. “This partnership is a testament to our past and present leadership, innovation and commitment to this field. We are inspired by the confidence that with the right resources and research teams, we will be able to make a meaningful impact towards a cure for HIV.”

UNC-Chapel Hill and GSK will focus on the latest scientific approaches to curing HIV, including a leading research approach toward an HIV cure, sometimes called “shock and kill.” This approach seeks to reveal the hidden virus that persists in people with HIV infection despite successful drug therapy, and augment the patient’s immune system to clear these last traces of the virus and infected cells. Part of this new paradigm was first tested at UNC-Chapel Hill and in 2012 a team led by UNC-Chapel Hill researchers demonstrated that latent HIV might be unmasked by new therapies. Recently, researchers at the university received Food and Drug Administration approval for a study in HIV-positive volunteers to combine this technique and an immune-boosting strategy.

David Margolis, MD

David Margolis, MD

“After 30 years of developing treatments that successfully manage HIV/AIDS without finding a cure, we need both new research approaches to this difficult medical problem and durable alliances of many partners to sustain the effort that will be needed to reach this goal,” said Dr. David Margolis, Carolina professor of medicine and leader of the Collaboratory of AIDS Researchers for Eradication (CARE). “The ‘shock and kill’ approach has shown significant promise in early translational research on humans and has been the focus of research for the last several years.”

“Although today’s treatments for HIV mean that millions of lives have been saved, people still have to take a lifetime of treatments, which takes an emotional toll and places an economic burden on society that is particularly challenging in countries with limited resources,” said Zhi Hong, senior vice president and head of the Infectious Diseases Therapy Area Unit at GSK. “This is why we must dedicate the next 30 years to finding a cure and scaling it up so that one day we will end the HIV/AIDS epidemic.”

Through the new company, GSK will invest $4 million per year for five years to fund the initial HIV Cure center research plan, and a small research team from GSK will move to Chapel Hill to be co-located with UNC researchers. The University will provide world-class laboratory space on its medical campus for the HIV Cure center and the new company. GSK will be contributing its expertise and know-how in medicines discovery, development and manufacturing, and UNC-Chapel Hill will bring to the table its research and translational medicine capabilities, talent, as well as access to patients and funding.

GSK’s investment in the HIV Cure center is separate from its investment in the discovery of novel antiretroviral (ARV) therapies in support of ViiV Healthcare, a global specialist HIV company dedicated to delivering advances in treatment and care for people living with HIV and owned by GSK, Pfizer and Shionogi. GSK’s HIV Discovery Performance Unit will continue its work on new ARVs in the Research Triangle Park area of North Carolina. ViiV has significant clinical expertise and will play an advisory role to the HIV Cure center and Qura Therapeutics.

Inclusion in START Trial Continues UNC’s History of HIV Research Informing Treatment Guidelines

David Wohl, MD, leads UNC's AIDS Clinical Trials Unit.

David Wohl, MD, leads UNC’s AIDS Clinical Trials Unit, and spoke about the START Trial results on WRAL. Click photo to watch the Health Team’s segment.

The Strategic Timing of AntiRetroviral Treatment (START) study released findings recently that changed worldwide treatment guidelines. The University of North Carolina at Chapel Hill was one of three sites in the state that participated in this clinical trial, which found that starting people living with HIV on treatment earlier in their disease course protects them from death as well as co-morbid conditions related and unrelated to AIDS. The study prompted the World Health Organization (WHO) to changes its global HIV treatment guidelines in September.

START, conducted through the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT), included 215 sites in 35 countries.  The trial enrolled and randomized 4,685 men and women who were infected with HIV and whose CD4 cell counts were above 500/mm3  (normal CD4 cell count is 1,000) to start HIV therapy immediately or to defer treatment until when their counts fell to 350 cells/mm3 or there was a clinical indication for HIV therapy.  After approximately three years of on-study follow-up, an independent data and safety monitoring board review found that there was a highly statistically significant difference between the early HIV therapy and deferred arms for the composite primary outcome of AIDS events, serious non-AIDS events, or death that favored the early treatment arm.

At UNC, 16 patients were enrolled in the trial. David Wohl, MD, Site Leader of the UNC AIDS Clinical Trials Unit at Chapel Hill, says the trial should be the end of a debate regarding the timing of HIV therapy that has raged since the first HIV medications became available.

“While other studies have suggested a benefit of antiretroviral treatment (ART) early in the course of HIV disease, the START study is the last word on ART, and we at UNC keep showing that early antiretroviral therapy is not only better and safer for the person living with HIV, but also for infection control,” Wohl says.

Wohl recently completed a six-year term on the U.S. Department of Health and Human Services (DHHS) ART guideline panel, serving on a subgroup advising exactly when to begin ART. These guidelines eliminated CD4 count thresholds for starting HIV therapy in 2013 and recommend ART to all with HIV regardless of CD4 cell count. Wohl notes that the WHO looked at the START trial’s results and changed its current recommendation to include more people living with HIV. Prior to START, the WHO recommended ART for those with a CD4 cell counts of 500 cells/mm3 or less.

UNC's Kevin Robertson, PhD, leads the neurology substudy of the START trial.

UNC’s Kevin Robertson, PhD, leads the neurology substudy of the START trial.

The results of the START Trial complement the findings of the HIV Prevention Trials Network (HPTN) 052 study. That trial was led by UNC’s Myron Cohen, MD, Co-Principal Investigator of the HPTN and Chief of UNC’s Division of Infectious Diseases. Dubbed the ‘Breakthrough of the Year’ by the prestigious medical journal Science in 2011, HPTN 052 demonstrated that ART was effective in preventing sexual transmission of the virus. An analysis of clinical outcomes also showed that ART given earlier also protected the health of those treated. Cohen’s four-year follow up confirmed the durability of treatment during the International AIDS Society’s meeting in Vancouver in July 2015.

These results influencing treatment guidelines are just a few examples of notable HIV findings to come out of UNC. A substudy of the START trial is a neurological trial being led by UNC Neurologist Kevin Robertson, PhD, which seeks to further study the connection of ART on the brain and cognitive function.

“Based on studies that we have been a major part of at UNC, we know that HIV gets into the brain early, and also that antiretroviral treatment improves neurocognitive functioning – how people think and remember – later in the disease,” says Robertson. “What we hope to document in the START Neurology substudy is that early antiretroviral treatment will protect the brain over the long term, so individuals with HIV can have productive lives, as we continue to follow these participants over the years.”

The START neurology substudy is still in analysis and results are forthcoming.

Researchers Identify Timeline for HIV Replication in the Brain

A team of researchers has discovered HIV can begin replicating in the brain as early as four months after initial infection. The study followed 72 treatment naïve participants during the first two years of HIV infection. Through analysis of cerebral spinal fluid (CSF) and blood samples, 20 percent of subjects showed replication in the central nervous system (CNS) at four months. Additionally, 30 percent of participants showed evidence of a marked CSF inflammatory response in at least one time point and 16 percent of study volunteers showed a marked CSF inflammatory response at multiple time points, suggesting an ongoing infection in the CNS. The findings will be published in the scientific journal PLoS Pathogens.

“This shows that viral replication and inflammation can occur early in infection with the concern being that the damage caused could be irreversible,” says study virologist Ronald Swanstrom, PhD, Director of the University of North Carolina’s Center for AIDS Research (CFAR) and Professor of Biochemistry and Biophysics at UNC’s School of Medicine. “HIV and inflammation have the potential to accelerate the aging process and cause neurocognitive impairment, in the extreme case resulting in HIV-associated dementia.”

One-third of people not taking antiretroviral therapy (ART) to control their HIV will eventually develop HIV-associated dementia, Swanstrom says. For him, the study’s results in these newly infected people stress the importance of routine HIV testing to catch the infection as early as possible to allow the prompt initiation antiretroviral therapy.

Ron Swanstrom, PhD

Ron Swanstrom, PhD

“This is yet another reason we want people on ART right away to limit the possibility of replication and inflammation in the brain,” Swanstrom says.

Future studies could focus on whether or not damage to the brain caused by this early replication and inflammation is reversible. Swanstrom collaborated on the study with senior author and neurologist Serena Spudich, MD, Division Chief of Neurological Infections & Global Neurology and Associate Professor of Neurology at Yale School of Medicine, and neurologist Richard Price, MD, Professor of Neurology at the University of California San Francisco School of Medicine. The first author on the study was a UNC graduate student in the Department of Microbiology and Immunology, Christa Sturdevant, who is now a postdoctoral fellow at Duke University. The study was funded by the National Institute of Mental Health.

Our Dr. Myron Cohen Speaks to ABC News 11 about Living in 2015 with HIV After Charlie Sheen Announcement

ID Faculty and Staff Earn Many Awards and Honors this Fall

Malaria researcher Jon Juliano, MD, Assistant Professor of Medicine, and Irving Hoffman, PA, MPH, Research Professor of Medicine, and U.S. Director of UNC Project-Malawi, with the Shepard Award.

Malaria researcher Jon Juliano, MD, Assistant Professor of Medicine, and Irving Hoffman, PA, MPH, Research Professor of Medicine, and U.S. Director of UNC Project-Malawi, with the Shepard Award.

UNC’s Division of Infectious Diseases faculty, staff and trainees have been earning many awards and honors this fall. Read more about the CDC honoring our UNC Project-Malawi site, two faculty chosen to participate in ACCLAIM, one of our new ID Fellows taking third place at a recent clinical research awards ceremony, and our contracts and grants manager’s photo landing in the top 10 for UNC Health Care’s 2015 Photography Contest.

UNC Project-Malawi Wins CDC Shepard Science Award
UNC’s Institute for Global Health & Infectious Diseases’ UNC Project-Malawi site received the U.S. Centers for Disease Control and Prevention (CDC) Charles C. Shepard Science Award. The UNC Project-Malawi site was one of the 11 African sites that received this honor from the CDC for participating in the RTS,S Clinical Trial Partnership. This partnership tested Mosquirix (RTS,S), a malaria candidate vaccine in Sub-Saharan Africa, and found it helped prevent malaria in children aged six weeks to 17 months.

Established in 1986, the CDC/ATSDR Charles C. Shepard Science Award was named in honor of Charles C. Shepard, M.D., the internationally recognized microbiologist who was chief of the Leprosy and Rickettsia Branch at CDC for more than 30 years, until his death on February 18, 1985. The Charles C. Shepard Science Award is presented to the best manuscript on original research published by a CDC or ATSDR scientist in a reputable, peer-reviewed journal. Click here to learn more about the RTS,S Clinical Trial Partnership.

New ACCLAIM Cohort Features Two Infectious Diseases Faculty

Arlene Seña-Soberano, MD, MPH, is one of two ID faculty in this year's ACCLAIM cohort.

Arlene Seña-Soberano, MD, MPH, is one of two ID faculty in this year’s ACCLAIM cohort.

Arlene Seña-Soberano, MD, MPH, and Michelle Floris-Moore, MD, both from UNC’s Division of Infectious Diseases, have been chosen to participate in the one-year Academic Career Leadership Academy in Medicine (ACCLAIM). Launched in 2012, ACCLAIM is a UNC School of Medicine program that provides leadership and career development opportunities to junior faculty members with an emphasis on those underrepresented in medicine.

One of the central requirements of ACCLAIM is that participants propose an idea that they will work on individually to advance research, strengthen teaching and improve the health care system.

Seña-Soberano is an Associate Professor of Medicine at UNC as well as the Medical and Laboratory Director of the Durham County Public Health Department. She also researches sexually transmitted infections, specifically HIV, hepatitis C virus (HCV), Trichomonas vaginalis and syphilis.

“I think that it is important to expand HCV testing, linkage to care and treatment for our patients seen at UNC Clinics,” says Seña-Soberano. “Through the ACCLAIM program, I hope to engage key leaders in our healthcare system to start thinking about innovative, feasible and cost-effective approaches for HCV care among our providers.”

Michelle Floris-Moore, MD, will focus her ACCLAIM project on the metabolic and cardiovascular complications of HIV.

Michelle Floris-Moore, MD, will focus her ACCLAIM project on the metabolic and cardiovascular complications of HIV.

Floris-Moore is a Clinical Associate Professor of Medicine. Her research focuses on the metabolic and cardiovascular complications of HIV.

“As I translate the results of my research on cardiovascular disease in HIV infection to the bedside to improve management of modifiable CVD risk factors among HIV-infected patients at UNC, interdisciplinary team management and leadership skills will be crucial,” says Floris-Moore. “The ACCLAIM program provides an excellent opportunity for me to further develop these skills and network with established UNC Health Care leaders to provide comprehensive care for our patients.”

The idea for ACCLAIM was based, in part, on the model established by the Public Health Leadership Program (PHLP) in UNC’s Gillings School of Global Public Health. To learn more about the ACCLAIM program, contact the UNC’s Office of Faculty Affairs.

ID Fellow Ross Boyce,  MD, MSc, is pictured with his son by his poster at the ASTMH meeting.

ID Fellow Ross Boyce, MD, MSc, is pictured with his son by his poster at the ASTMH meeting.

ID Fellow Ross Boyce Wins Research Award for Malaria Research in Uganda
Ross Boyce, MD, MSc, Infectious Diseases Fellow at UNC, earned third place at the Elsevier-American Society of Tropical Medicine and Hygiene (ASTMH) Clinical Research Awards during the society’s meeting in October. Dr. Boyce’s research showed improved clinical outcomes with the introduction of rapid diagnostic testing for malaria in rural Uganda. The Elsevier-ASTMH Clinical Research Award is given to students (within six months of completing undergraduate or master’s level training, including medical undergraduate degrees) and post-doctoral fellows who are conducting clinically-oriented research with scientific clinical content.

Click here to learn more about the Elsevier Clinical Research Award.

Contracts and Grants Manager Jim Kenny Lands in Top Ten for Photography Contest

Contracting and Grants Manager Jim Kenny's photo "Saved a Seat for You" is a finalist in the 2015 Photography Contest sponsored by UNC Health Care Employee Recreation & Wellness.

Contracting and Grants Manager Jim Kenny’s photo “Saved a Seat for You” is a finalist in the 2015 Photography Contest sponsored by UNC Health Care Employee Recreation & Wellness.

By day, Jim Kenny is a member of the two-person team that runs the Division’s Contracting and Grants office. Outside of work, he is an accomplished photographer. His photo entitled “Saved a Seat for You” landed in the top 10 photos of the 2015 Photography Contest sponsored by UNC Health Care Employee Recreation & Wellness. It was one of 300 submissions. The top photographs will be enlarged, framed and displayed by Employee Recreation & Wellness for one to two years. The online balloting surveys are being finalized and will be submitted to Employee News Online for publication soon. To vote for “Saved a Seat for You” make sure to participate before Nov. 30. In addition, photocopies of each of the winning entries will be on display in the corridor that runs from the NC Memorial Hospital to the Corner Café.

Lynda Bell Brings Patients from Illness to Wellness

Lynda Bell, ANP-C, MSN, has treated patients living with HIV at UNC's ID Clinic since 1992.

Lynda Bell, ANP-C, MSN, has treated patients living with HIV at UNC’s ID Clinic since 1992.

At the end of 2015, Lynda Bell, ANP-C, MSN, will do something she hasn’t done since 1966 – take a break from nursing. Her career as an adult nurse practitioner at UNC’s Infectious Diseases (ID) Clinic in NC Memorial Hospital has spanned more than two decades. Born in Wilmington, but raised in New York City, Bell originally dreamed of becoming a journalist.

“But most of the women on my mother’s side of the family were nurses,” Bell says. “And my mom told me ‘you will always have a job if you become a nurse.’”

Her mother planted the idea of nursing in her mind, but it was a phone conversation with her father that helped her career blossom as an infectious diseases nurse practitioner specializing in treating people living with HIV.

“Before the advent of the protease inhibitor class of antiretroviral medications in the mid-1990s, I lost a lot of my patients,” Bell says. “I remember losing a mother, a father and their two children in the early 1990s at UNC. I called my father and told him I would have to move back to New York. I couldn’t handle it anymore. It was breaking my heart to watch many of my patients die a slow agonizing death, and, then to lose an entire family, this broke my spirit. But my father told me no. He said ‘You have to stay. Your patients need you. You have a passion for bringing patients from illness to wellness.’ So I found a way to stay.”

What Bell found was a family among her colleagues at UNC. She found solace in weekly meetings with then UNC hospital chaplain Peter Maffly-Kipp. She found mentoring from former associate ID clinic director Susie Wilson. And she found respect among the physicians she worked alongside treating North Carolinians living with HIV.

“Working here at UNC has never meant working alone,” Bell says. “There is always someone to consult with or run something by. In my 24 years in the ID Clinic, I have never had a physician tell me they are too busy to answer any question I had. The concept of teamwork and collegiality is exemplified by all the providers in the ID Clinic.”

Christopher Hurt, MD, says patients are fortunate to have been treated by Bell and he is grateful for her mentoring.

Christopher Hurt, MD, says patients are fortunate to have been treated by Bell and he is grateful for her mentoring.

Christopher Hurt, MD, works in the ID Clinic with Bell and says he respects her dedication to UNC’s patients, her willingness to tackle any new challenge and her ability to put patients and colleagues at ease.

“Lynda is among the most thorough clinicians with whom I’ve ever worked, and her commitment to doing the right thing has been a model for me and other trainees and colleagues; working alongside her has made me a better doctor,” says Hurt. “She is incredibly generous with her time and efforts, and I’ve tried really hard not to take for granted the fact that if I ask her how to do something, there’s a pretty good chance she’ll drop what she’s doing and take care of it herself, just to be helpful – before I have a chance to catch her. Our clinic has been so very fortunate to have her as a provider, a leader, and a colleague for so many. I’m happy for her that she’ll have more time to spend with friends and family in her retirement, but am saddened that future patients won’t have a chance to experience her commitment to care and genuine interest in their well-being.”

The Road to North Carolina
Bell began her career in 1968 at Jacobi Hospital in the Bronx, working on a general medicine floor and then in the emergency department. She was living in Harlem and enjoyed heading to the famed Apollo Theater for shows, like The Jewel Box Review.

“The Jewel Box Review was a show performed four times a year at the Apollo by transgender men and women,” says Bell. “It was fabulous entertainment. When the AIDS epidemic emerged in New York City, many of my patients were men who had sex with men or transgender. I think watching the diverse culture and lifestyle of the gay and transgender men and listening to their experiences prepared me for the HIV care I provide today. I wasn’t afraid to treat people dying from AIDS. Some were residents in my neighborhood. This was the first time in my career that I was witnessing an epidemic. We were trying so hard to understand the virus, the treatment and the transmission. I wanted to help.”

But raging at the same time as the AIDS epidemic in New York was the increasing amount of crime committed mostly by people who were indigent, estranged from their families, disempowered and addicted to street drugs. A trip to North Carolina motivated Bell to move.

“I came to North Carolina to visit a friend, and I fell in love with the tall, beautiful trees and the sense of comfort,” Bell says. “I really didn’t feel happy in Harlem any more. I moved in 1992 and have been at UNC working in the Division of Infectious Diseases ever since.”

Amy Heine, MSN, FNP, works with Bell in the ID Clinic.

Amy Heine, MSN, FNP, works with Bell in the ID Clinic.

At that time the ID Clinic was run by Susie Wilson, who Bell says taught her the importance of good documentation, evidence-based practice and providing quality care to each patient. When Wilson left the clinic in 2002, Bell replaced her as associate director. This is a position she continues to hold until the end of the year. Amy Heine, MSN, FNP, works with Bell in the ID Clinic.

“I have great respect for Lynda. She is an amazing advocate for HIV positive patients in our clinic, throughout the UNC Healthcare system and in the community,” Heine says. “Her level of commitment, professionalism and work ethic is admirable. We are presented with new challenges and situations every day in the clinic and knowing you have the support of your colleague is invaluable. Over the years of working together, I have found that a sense of humor and laughter has helped us succeed.”

The Plan for Retirement
Although she officially retires at the end of 2015, Bell says she hopes she can return one day a week to see patients.

“HIV science has brought us so far over the years,” she reflects. “I remember when we first started prescribing protease inhibitors. The patients gained weight. The hair stopped shedding. The skin cleared. The mentation improved. They stopped dying, started living and were able to focus on their goals in life. Some wanted to go back to school. Some wanted to get a job. Others wanted a family. Over the past twelve years, I’ve joyfully collected pictures of my patients’ graduations, promotion ceremonies, children, grandchildren and trips to foreign countries. The science has improved over the years to really improve our patients’ quality of life. I would never have imagined back in the late 1980’s that one day our patients would be on a single tablet antiretroviral regimen. I spend most of my time now helping patients manage their co-morbidities, like high blood pressure and diabetes, than I do helping them control their HIV. This is the first time we have had an aging population of people living with HIV. So I am not going to leave the clinical practice quite yet.”

Bell already has plans for retirement, but hopes to also stay involved at the ID Clinic.

Bell already has plans for retirement, but hopes to also stay involved at the ID Clinic.

But the other six days a week Bell will spend pursuing hobbies, learning new skills and catching up with family. She is already signed up for a computer literacy class at the local library as well as a literary arts course as she would like to one day write a memoir about her career as a nurse practitioner as well as a science fiction novel. Bell is looking forward to being able to spend more time swimming, power walking and reading. Her favorite authors are Isabelle Wilkerson, Michelle Alexander and Ta-Nehisi Coates. She will also travel to New York and New Jersey to see her son and five grandchildren.

“Even though I always kept a busy clinical practice at UNC, I never missed any of my grandchildren’s birthdays, recitals or school awards ceremonies,” Bell says. “I would leave work and drive the eight and a half hours to New York to cheer them on. I look forward to continuing to do that in retirement.”

Recent UNC Grad Hones Research and Clinical Skills at UNC Project-Malawi

MacLean, left, four years ago at the UNC homecoming football game

Sarah MacLean, left, four years ago at the UNC homecoming football game.

For Sarah MacLean, UNC Class of 2015, interning with UNC Project-Malawi is the perfect fit for the year after graduation.

“When I was looking at post-graduation opportunities, I was hoping to combine my interest in learning about different cultures with my interest in medicine,” MacLean says. “This internship with UNC Project-Malawi is exactly what I was looking for. Of course, it was an added bonus that I would continue my connection to UNC.”

MacLean, who majored in global studies while completing pre-medical courses, is spending a year in Lilongwe, Malawi, working primarily on HIV prevention research. In addition to collaborating with Malawian researchers and UNC faculty, she has enjoyed learning from the numerous other students and fellows at UNC Project-Malawi.

“We all come from such different backgrounds, but have common interests,” she says. “I’ve really enjoyed collaborating with the other students and bouncing ideas off each other.”

MacLean was first introduced to the various aspects of global health during her time as an undergraduate at UNC. She completed clinical observations in Santiago, Chile, while studying abroad and worked with children with special needs in Cusco, Peru, as an Eve Carson Scholar.

Sarah MacLean, right, with fellow UNC Project-Malawi intern Savvy Brar hiking near Lilongwe.

Sarah MacLean, right, with fellow UNC Project-Malawi intern Savvy Brar hiking near Lilongwe.

“When I came back from South America, I was itching to go abroad again. I didn’t expect my next adventure to be in Africa, but I’m so glad that UNC Project-Malawi has this internship,” MacLean says. “Now I couldn’t imagine doing anything more meaningful or eye-opening during the year after graduation.”

During the two months she has been in Malawi, MacLean has gotten involved with several research projects at various stages of completion. She primarily works under William Miller, MD, PhD, MPH, on a study that provides a partner Sexually Transmitted Infection (STI) notification intervention for patients to identify partners unaware of their HIV status. MacLean has been a pivotal part of the initial implementation and the study’s data management.

“Sarah has been a tremendous asset for us,” says Miller. “She stepped right in after arriving in Malawi and has performed at a very high level. It is a great situation where she learns from doing, and we benefit from a bright, motivated, conscientious young woman.”

MacLean has also been working on analyses of mental health and substance use amongst female sex workers – a key population at risk for HIV.

“A lot of the extracurricular work I did as an undergrad was related to mental health and gender issues, so working on this analysis is really exciting,” MacLean says.

Her mentor for this research project is Kathryn Lancaster, PhD, MPH, a post-doctoral research associate in UNC’s Institute for Global Health & Infectious Diseases.

“Sarah is very talented with a great attitude that is infectious,” says Lancaster. “We’re lucky to have her on our team as she is eager to learn and contribute to our analyses.”

MacLean, second from left, enjoying brunch with UNC IGHID faculty,

MacLean, second from left, enjoying brunch with UNC IGHID faculty Mina Hosseinipour, MD, MPH; Bill Miller, MD, PhD, MPH; and Kathryn Lancaster, PhD, MPH.

MacLean has also been shadowing UNC Project-Malawi clinicians to gain a greater perspective on how medicine is practiced in a resource-limited setting. She plans to attend medical school after taking two years off from school. “The experiences I’m having here will undoubtedly make me a better research clinician in the future,” she says.

Outside of work, MacLean has enjoyed exploring Malawi and learning Chichewa. “I’ve never been to this region of the world, so I’m trying to soak up as much as possible during this year,” she says.

MacLean will be returning to the US in July 2016. She hopes to build off of the knowledge and experience she gains here in her future employment and studies.

“During my time as an undergrad at UNC, I learned so much about global health, but nothing can compare to seeing global health first-hand,” says MacLean. “I’m so lucky that I get to spend this year learning outside of the classroom.”

Researchers Discover Link Between Small Mammals and Evolution of Hepatitis A Virus to Humans

Stanley Lemon, MD

Stanley Lemon, MD

Researchers at the University of North Carolina at Chapel Hill (UNC) are part of an international team led by the University of Bonn, Germany, who have found a link between the origin of hepatitis A virus (HAV) and small mammals. With the emergence of Ebola virus from bats and hantaviruses from rodents, investigators say identifying the other species infected with HAV provides novel insight into the evolution of HAV and how it spread to humans, and highlights the utility of analyzing animal reservoirs for risk assessment of emerging viruses.

“Prior to this study, we had no understanding of the origins of HAV, an ancient and common threat to health in many regions of the world”, says Stanley M. Lemon, M.D., one of the study’s authors and a professor of medicine at UNC’s School of Medicine and UNC’s Institute for Global Health & Infectious Diseases (IGHID). “Now we know that it evolved among small mammals such as bats, and spread from them to humans in the distant past.” The paper “Evolutionary origins of hepatitis A virus in small mammals” was published in the Proceedings of the National Academy of Sciences (PNAS) in early November.

Hepatitis A virus causes vomiting, fatigue, fever, jaundice and inflammation of the liver. The virus is excreted in feces and can survive in the environment for prolonged periods of time. In the United States, HAV is typically acquired by ingestion of feces-contaminated food or water, as was the case in a 2013 outbreak of contaminated pomegranates in the southwestern US and Hawaii. Infection can also result from close personal contact with an infected household member or sex partner.

An HAV vaccine was developed in 1995 and has drastically reduced the number of cases of HAV in the US and many other countries. However, in developing countries in Africa, South America, Asia and the Middle East, vaccine use is limited and the spread of HAV is greatly facilitated by poor sanitary conditions. In fact, the World Health Organization (WHO) estimates in countries where HAV is endemic, all children are infected with HAV before the age of 9.

As part of a consortium of investigators, Lemon and colleagues at the University of Bonn in Germany and several international collaborators discovered that closely related HAV-like viruses exist in bats, rodents, hedgehogs and shrews by testing 15,987 samples collected from 209 diverse mammal species globally.

“Our study exemplifies the utility of looking beyond phylogenetic criteria alone when conducting risk assessment for emerging RNA viruses and the need to include functional, ecologic, and pathogenic analyses of animal reservoirs,” says Jan Felix Drexler, M.D., the study’s corresponding author and a professor of medicine at the Institute of Virology at the University of Bonn Medical Centre in Germany. “Next steps may include efforts to grow these viruses in cell culture and functional analyses to assess their risk of being transmitted to primate hosts.”

This study received funding from the National Institutes of Health to the University of North Carolina at Chapel Hill (R01-AI103083 and U19-AI109965).

Our Drs. Wohl and Leone Discuss How Bacteria May Help Fight Viruses Like HIV

UNC School of Medicine Student-led Group Provides Critical Health Services for Honduran Women

HHA 2015 group

The 2015 edition of the Honduran Health Alliance brought together attending physicians, rising fourth- and second-year medical students, and students from the Gillings School of Global Public Health.

This is the first experiential education story written for UNC’s new campus-wide global health e-newsletter Quarterly Global Health Happenings. Zach Read, Communications Specialist for UNC School of Medicine and UNC Health Care, wrote this story. Summer 2015 marked the twelfth annual community health clinic led by the Honduran Health Alliance, a UNC School of Medicine student group that provides critical health services for Honduran women, clinical education for UNC medical learners, and experiences that inform the careers of future doctors. To learn more, visit http://news.unchealthcare.org/.

The summer after her freshman year of college at UNC, Morehead-Cain Scholar Helen Powell, of Burlington, North Carolina, spent eight weeks assisting in a primary care clinic in Nicaragua, where she improved her Spanish-speaking skills while working alongside Nicaraguan physicians and nurses.

The experience exposed Powell, who planned to attend medical school, to health care in a developing nation – and to the value of serving underserved populations.

“After that summer, I knew I wanted international experiences part of my medical school education,” says Powell, a second-year student at the UNC School of Medicine. “But that project encouraged me to try something different as a medical student – to pursue an international health opportunity that was team-based and led through a structured, organized program.”

Helen Powell, MS2, sees a patient during HHA clinic week.

Helen Powell, MS2, sees a patient during HHA clinic week.

This past summer, she was one of 16 UNC medical students to travel to Honduras with the Honduran Health Alliance, or HHA, a UNC School of Medicine student-led group that provides health services to women in El Corpus, Honduras, and surrounding rural communities. For the past 12 years, for three weeks in the summer, HHA has offered women in these areas health education, family planning, cervical cancer screenings, sexually transmitted infection treatment, and other services.

Desiree Coutinho, a fourth-year UNC medical student who traveled with HHA two years ago, organized the 2015 trip with fellow fourth-year student Tyler Warmack. A Charlotte-area native who attended Furman University as an undergraduate, Coutinho has had several international educational experiences, from Latin America to India to the Dominican Republic. HHA stands out among them.

“The ties that UNC students have formed in Honduras have helped establish the program,” says Coutinho, who will specialize in pediatric anesthesiology when she moves on to residency. “When medical mission work is done correctly, with dedication from the providers and from those in the communities, as well as the kind of institutional support the School of Medicine provides through the Office of International Activities, it’s incredibly valuable to the patients and the volunteers.”

The 2015 group consisted of eight rising fourth-year and eight rising second-year medical students, four UNC attending physicians, and two maternal public health students from the Gilling School of Global Public Health. The trip was structured similarly to previous years: during week one, health education was provided to women in rural communities; during week two, clinics were held Madrigales, a small community about 45 minutes away from El Corpus; and during week three, pap smear results were returned to patients.

Over the seven-day clinic period, HHA saw 567 women, including 124 in one day, and performed 291 pap smears. In years past, younger and older students were paired and saw patients together, but the high level of interest from women this summer required the group to adjust its plans to meet the needs of the patients.

“Because so many women arrived for services, rising second-years had to take histories on their own and report to the older students and attendings about what they found,” says Coutinho. “Time constraints and resource limitations required every one of us, including younger students, to step into the role of assessing, analyzing and examining the patient, while also ensuring that every woman was seen and well cared for before dark.”

Coutinho was impressed by the development of the younger students during the trip.

Fourth-year medical student Desiree Coutinho sees a patient.

Fourth-year medical student Desiree Coutinho sees a patient.

“They adjusted to the realities of our clinic and truly embraced and excelled at what was asked of them,” she says. “They were excited to learn, get their hands dirty, and work hard.”

Traditionally, HHA has emphasized mentorship between students. Younger students, with the guidance of older students and attendings, apply what they’ve learned during their first year of medical school. Fourth-year student Sean Miller, from Fayetteville, North Carolina, had traveled internationally on medical missions, but HHA and its emphasis on mentorship was a new experience.

“It was helpful for me from a teaching standpoint,” says Miller, who will soon decide between emergency medicine and surgery for his specialty. “This is the first clinical work rising second-year students do, so we helped them with their presentations and their clinical thinking. I wasn’t expecting teaching to be quite as much fun as it actually was. It pushes you to think about what you know and don’t know and how best to teach someone else – it helps you grow and expand your knowledge.”

Christina Cronk is a fourth-year student from Greensboro, North Carolina, who plans to specialize in family medicine. She participated in HHA two years ago and returned this past summer. She, too, valued the mentorship aspect of HHA, which reminded her how exciting it was to see patients on the trip in 2013.

“This experience taught me that I like mentoring and teaching and that I might want to pursue them in my future career,” says Cronk. “It’s made residency even more exciting to think about because we’ll have the opportunity to mentor and teach medical students.”

L-R Dana Neutze, MD; Caroline Roberts, MD; fourth-year students Tyler Warmack and Desiree Coutinho; Narges Farahi, MD; and Kim Newton, MD, MPH.

L-R Dana Neutze, MD; Caroline Roberts, MD; fourth-year students Tyler Warmack and Desiree Coutinho; Narges Farahi, MD; and Kim Newton, MD, MPH.

Cronk was especially pleased with the dynamic that developed between this year’s HHA students and the attendings on the trip, including UNC Family Medicine physicians Narges Farahi, MD; Dana Neutze, MD; Kim Newton, MD, MPH; and Caroline Roberts, MD.

“After your first year of medical school, you have little snippets of interaction with attendings – HHA is an opportunity to have more targeted mentorship from attendings who are very mission-driven, kind, and enthusiastic, and who want to get to know you,” she says. “That makes a huge difference as a student – having someone who’s excited about teaching you in a very unique setting where you get to work with them for a long amount of time.”

For second-year medical student Helen Powell, learning from older peers gave her a new perspective on how much she’s already learned and how much more there is for her to learn during the rest of her medical school education.

“It was clear how much experience they have,” says Powell. “During nightly debriefings, the younger students remarked on how experienced all the fourth-years were, even if they were only two years ahead of us. For me, that speaks volumes about how valuable the clerkship phase of medical education is and how important time seeing patients is in our development.”

Prior to the trip, Powell and the rest of the rising second-year students hadn’t had formal training in women’s health. On Wednesday nights, before going to Honduras, the group met for class lessons on prevalent women’s health issues in the country and how to handle them – for example, which antibiotics to prescribe for which sexually transmitted infections.

“The preparation was helpful, but there’s nothing like learning by doing,” says Powell. “The knowledge we have after the trip is so much greater than before we left, and it’s going to be so valuable for each of us moving forward as we experience clinical rotations.”

The clinical experiences were also valuable for the fourth-year students.

Eight second-year students were on the HHA trip this summer, which gave them their first opportunity to see patients. L-R: Elizabeth Stephenson, Haley Holoway, Jamie Prince, Hannah Jones, Katherine Lee, Katelyn Rittenhouse, Helen Powell, Erica Andrews.

Eight second-year students were on the HHA trip this summer, which gave them their first opportunity to see patients. L-R: Elizabeth Stephenson, Haley Holway, Jamie Prince, Hannah Jones, Katherine Lee, Katelyn Rittenhouse, Helen Powell, Erica Andrews.

“On other medical missions I’ve been on, I did health screenings,” says Miller. “HHA provided the opportunity to perform pelvic screenings and services that might be useful to me if I decide to pursue emergency medicine, where you have to be comfortable with the procedure.”

For many of the students on the 2015 trip, the summer experience has shaped their future plans and how they think about medical education. Several insist they will make international health work part of their future careers.

“I know that I want to work with women, utilize my Spanish-speaking skills, and serve underserved populations,” says Cronk.

Powell would like to continue going overseas as well, but it’s too early for her, and most second-year students, to know what area of medicine they’d like to focus on.

“We have so much more to do here before we can make that decision,” says Powell. “But the trip, with the various levels of medical education represented, demonstrated the power of being part of this prestigious, professional culture. It reminds me how fortunate I am to be here.”

The UNC School of Medicine’s Office of International Activities provides oversight and financial support for the Honduran Health Alliance. For more information about the Office of International Activities, visit https://www.med.unc.edu/oia. For more information about the Honduran Health Alliance, visit https://www.med.unc.edu/hha.