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People under the age of 30 account for the majority, or 40 percent, of new HIV infections in the United States. This age group is also more likely than adults to own a smartphone and use this device to download apps and access health information. Recognizing adolescents’ connection with mobile technology, a research team at the University of North Carolina at Chapel Hill, along with colleagues at Emory University, has secured $18 million in funding over the next five years from the National Institutes of Health to form the UNC/Emory Center for Innovative Technology or iTech.
“iTech will facilitate the execution of six research studies. Each study will use technology to address a barrier to the HIV care continuum,” said Lisa Hightow-Weidman, M.D., M.P.H., associate professor of medicine and principal investigator of the Behavior and Technology (BAT) Lab at UNC. “For youth at risk of becoming infected with HIV, we will develop apps that aim to increase HIV testing, and use of and adherence to pre-exposure prophylaxis (PrEP) to prevent HIV. For youth who test positive for the virus, we will develop electronic health interventions to engage them in care and improve adherence to antiretroviral therapy.”
Based at UNC, iTech includes seven sites around the US, allowing researchers to collaboratively develop the center’s health interventions. These health interventions will target 15-24-year-olds at risk for or currently living with HIV, specifically young men who have sex with men (YMSM). In 2010, YMSM accounted for 72 percent of new HIV infections among people aged 13-24. Hightow-Weidman said HIV disproportionately impacts African American and Latino YMSM; therefore, these groups will be a major focus of iTech’s interventions.
“Despite recommendations that high risk youth receive an HIV test at least annually, many YMSM have not been tested in the last year and more than half of youth with HIV are unaware of their infection,” Hightow-Weidman said. “Barriers to testing among youth include misperception of individual risk, fear of testing positive, concerns about confidentiality and access to healthcare services. Developing interventions to improve the uptake of HIV testing and facilitate entry into prevention and care services is the goal of our iTech studies.”
The award for iTech is one of three U19 applications funded by the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development to support the new Adolescent Medicine Trials Network (ATN). UNC’s Gillings School of Global Public Health also received funding for a U24 award to serve as the ATN’s Coordinating Center. The center will serve as the central resource for network communications, cataloging of biosamples, and data management.
Ankita Ashoka excelled at badminton as a child in Bangalore, India. She was ranked India No.1 in the under – 13 age division and a part of the Sub-Junior Indian team. This allowed her to train in one of the best badminton academy in India, led by the former All-England Champion- Prakash Padukone. She entertained the idea of going pro, but another passion surfaced, causing her to set athletics aside.
“If it weren’t for medicine, I would be a professional badminton player,” Ashoka says sitting on the UNC School of Medicine campus where she has been completing a clinical, and now, a research rotation.
In her final year of medical school in India, Ashoka decided to apply to UNC’s International Visiting Student Program. The program is managed by the UNC School of Medicine’s Office of International Activities (OIA). Since 2009, more than 650 international visiting medical students from 19 countries have trained at UNC through the OIA. All students must be in their final year of medical school and in good standing with their home university. They also must express how studying at UNC will allow them to realize their educational goals and long-term career plans.
“The goal of the OIA is to provide not only the international medical students the opportunity to responsibly engage in U.S. clinical practices and see the difference in diagnoses and treatments, but it is as worthwhile for the UNC medical team who have the opportunity to share cross-cultural practices in a clinical environment and ideally learn from one another,” says Shay Slifko, OIA Program Manager. “Our hope is to keep building and improving our resources for UNC students and international medical students alike. We work towards providing resources and support in helping them adjust to the American medical system during their short time here in a way that is beneficial for their future careers as medical providers.”
Ashoka arrived in Chapel Hill in October 2015. She spent two months rotating through UNC’s Division of Nephrology and credits the faculty and fellows there with easing her transition into a U.S. clinical setting.
“Dr. Vimal Derebail, Dr. Randy Detwiler and the fellows took great interest in introducing me to different patient-care settings” Ashoka says. “They gave me valuable insight into the field of nephrology and helped me emerge as a confident student by the end of the elective. It was an amazing eight weeks of getting to the know the kidneys.”
Ashoka then shifted her focus from the kidneys to the heart. She wanted to work with Ross Simpson, Jr., MD, PhD, Professor of Medicine, Director of the Lipid Prevention Clinic at UNC and the principal investigator of the SUDDEN research group, which focuses on investigating the causes responsible for out of hospital sudden unexpected death. Ashoka approached Slifko about rotating through a cardiology research elective. Slifko was supportive and connected Ashoka with Simpson. Ashoka is now studying the link between mental and substance use disorders and sudden unexpected death.
“More often than we realize, mental disorders have a great impact on physical health and could be a potentially disabling condition.” Ashoka says. “Medicine is an ever-evolving field. Research gives us a better understanding of what we already know, and sometimes leads us to new findings or refutes old findings. It helps us get ahead of ourselves and modify the practice of medicine.”
Ashoka recently submitted two abstracts to the American Heart Association and is now working on writing a manuscript. Ashoka says “I owe this to Dr. Simpson and Shay, who have been very encouraging.” Simpson says he is impressed with Ashoka’s drive and diligence.
“Ankita is industrious and self-starting,” Simpson says. “She took a leadership role in developing this project on mental health issues and victims of sudden cardiac death. She has learned the basics of clinical research and the skills needed to write scientific papers. I hope to train more students like her.”
Seeing a Happy Mom and Child
Ken Langwani cannot remember a time when he wasn’t thinking about science. Growing up in Blantyre, Malawi, he attended secondary school on a scholarship. Grateful for this funding to further his education, Langwani knew he wanted to devote his life to a career that allowed him to give back to the community.
“I decided to go to medical school and I have found obstetrics and gynecology to be very satisfying,” Langwani says. “You see an instant result. It is so nice to see a happy mom with her child.”
While completing his family medicine rotation at the Malawi College of Medicine in Blantyre, Langwani received an email from the dean of faculty for the college about the opportunity to train at UNC through the Office of International Activities. Langwani relished the thought of learning how OB/GYN is practiced in another country. He applied to the International Visiting Students Program and flew to Chapel Hill in May to begin his OB/GYN rotation.
“I noticed differences immediately,” Langwani says. “In Malawi, your days as an OB/GYN are long and our medical records system is still paper-based. In the US, physicians can hand patients off to another doctor and all of that patient’s information is electronically accessible.”
Langwani said one of the most fascinating moments of his four-week clinical elective with UNC’s Department of Obstetrics and Gynecology was seeing a blood transfusion to combat fetal anemia. He trained with Tara Castellano, MD, who said the team learned as much from Langwani as he did from them.
“Ken not only contributed to the patients he cared for, but also enriched our team by providing such an interesting clinical perspective as a student from Malawi,” Castellano says. “Ken was able to gracefully assimilate to an entirely different medical culture and system compared to that in which he has received his education. Not only that, but Ken managed it all with such an incredibly positive attitude. All the faculty, house officers and other students who met Ken were very lucky to have the experience of working, learning and growing with Ken.”
Langwani also completed a four-week elective in trauma and emergency surgery at UNC before returning to Blantyre. While many of his peers in the OIA’s International Visiting Students Program hope to practice in the US, Langwani looks forward to finishing his fifth and final year of medical school in Malawi enriched by the lessons he has learned at UNC.
“I want to be an OB/GYN in Malawi,” says Langwani. “That’s my whole plan, and it is where I am needed.”
Cancer Doesn’t Discriminate
Apoorve Nayyar will never forget hearing one of his former patients calling out his name at UNC.
“He was a burn victim we had been treating and one week before he was to be discharged, his heart stopped,” Nayyar remembers. “We immediately started CPR. Then a few weeks later I am walking through the hospital and he shouts, ‘Hey AP’, he had given me that nickname. I was so happy to see him.”
Being able to improve the health of each patient he meets is what has propelled Nayyar through five and a half years of medical school in India and now several electives through the UNC School of Medicine’s OIA’s International Visiting Students Program. Since arriving in March, Nayyar has completed one-month long electives in plastic surgery, burn surgery and vascular surgery.
“Apoorve is a great student,” says Michelle Roughton, MD, Assistant Professor and Program Director in the Division of Plastic and Reconstructive Surgery. “He is eager to learn and appreciative of instruction. He is enthusiastic about surgery and should excel.”
Like Ashoka, Nayyar also decided to pursue a research elective while at UNC. But the rotation he wanted did not exist. He contacted Slifko.
“Shay was able to create the surgical oncology elective for me to match my interests,” Nayyar says. “She is so dedicated. The entire experience with the OIA has been wonderful. Being accepted was a very clear, fair process. UNC’s Office of International Activities is ranked highly by U.S. News & World Reports and in the online residency forums about studying in the US. Now, I know why.”
Nayyar, who would like to eventually complete his residency in the US in surgical oncology, is most excited about participating in this research elective. His current project focuses on pancreatic cancer, which only has a 4 percent survival rate.
“I really want to help people move from a cancer diagnosis to remission,” Nayyar says. “I especially want to focus on the underserved population, who may not have health insurance. Cancer doesn’t discriminate between the rich and poor. We have been blessed to have access to healthcare; not everyone has that. I believe in the dream of equitable healthcare and want everyone to have the opportunity to remain in good health. This gives me the drive to broaden my knowledge and skills, each day.”
Click here for more information about the Office of International Activities.