Summer 2008 - Malawi

Institute sends record number of students for summer research

The Institute for Global Health an Infectious diseases is committed to providing international research opportunities for students off all levels and across campus. UNC has been active in the sub-Saharan African country of Malawi since 1989 and now operates a research, training and care facility in the capital called UNC Project. UNC Project offers students the opportunity to assist in many different studies and research activities.

Here are profiles of the students working in Malawi this summer. Read more about their experiences on the UNC-Malawi student blog!

Megan Parker

Megan Parker is a 4th year PhD student in the department of nutrition working with the BAN study in Lilongwe. The BAN study follows the infants of HIV-infected mothers from 0-12 months. Her research aims to evaluate the adequacy of the infant diet after abrupt breastfeeding cessation at 6 months and also to document the BAN mothers' experiences with the World Health Organization's HIV and infant feeding guidelines. After exiting the BAN study, a sub-sample of mother-infant pairs have a follow-up interview in which they are asked about their experiences and assess the health and well-being of the infants (now between 15-18 months). Megan's research is being funded by an R01 grant from the NIH awarded to Dr. Peggy Bentley in the School of Public Health.

Kate Patterson Gilles

Kate Patterson Gilles is a UNC MPH student who is working with the UNC Project to coordinate a small component of a Prevention of Mother to Child (PMTCT) Operations grant received from the Elizabeth Glaser Pediatric AIDS Foundation. The UNC Project offers PMTCT services through the Call to Action (CTA) program, which is based at Bwaila Hospital in Lilongwe. As part of this program, UNC is seeking to improve services offered to pregnant women who test positive for HIV but are not eligible for ART (to be eligible, an individual must have a CD4 count below 250 cells/ml or a WHO Stage 3 or 4 condition), including offering follow-up CD4 count testing 6 months and 18 months after the woman has given birth. The project that I am coordinating is looking at the best ways to track and remind women to return for those tests, and ways
to support and encourage them to return for this and other long term care services.

By encouraging women to receive regular CD4 count tests, the Project hopes to increase the number of women who are identified for ART initiation as soon as they become eligible. This in turn will improve the health and survival of those women who initiate ART soon after they become eligible, who might otherwise not seek care until they were seriously ill.

Kate's research is being funded through the Malawi Summer Institute in the Office of Global Health (SPH).

Cameron Taylor, Caryl Feldacker, and Prof. Michael Emch

With funding directly from the institute, Cameron Taylor, an undergraduate, and Caryl Feldacker, a graduate student, both in the department of geography, are conducting research and training on medical geography. Their work is being supervised by Michael Emch, PhD, who is associate professor of geography, a fellow at the Carolina Population Center and adjunct associate professor of epidemiology. The three are working closely with a couple of clinical trial study teams to enhance the effectiveness of their research through the use of GPS receivers. Cameron and Caryl will train the team to use GPS receivers (e.g. marking GPS points, navigating, and other GPS skills). With the skills they have learned, the field workers will be able to develop sophisticated databases which will make recruiting and following patients much easier.

They will also help with estimating HIV prevalence in Malawi by training additional health care workers in Lilongwe on the use of GPS receivers. Their 4-hour course includes both classroom learning and hands-on training. Topics include marking points, entering the information in a spreadsheet, navigating to find locations, and problem solving.

Lillian Brown

Lillian Brown is an MD/PhD student who will be spending the next year working with the STD clinic at Kamuzu Central Hospital to look at ways to improve HIV partner notification. The vast majority of HIV spread in sub-Saharan Africa occurs through heterosexual contact; when a new patient is discovered it is critically important to find sexual partners who require evaluation for therapy or prevention strategies. Partner notification involves informing the sexual partners of HIV-positive persons that they have been exposed and encouraging them to seek counseling, testing and other prevention and treatment services. We will collect qualitative and quantitative data to determine the best way to increase HIV counseling and testing among partners of patients who are diagnosed with HIV in the STD clinic. Lillian's research is funded by a development grant from the UNC Center for AIDS Research.

Jon Samuel

Dr. Jon Samuel is a medical resident at UNC who is conducting research on burn injury and HIV. His work is supported by the NC Jaycee Burn Center and the Center for AIDS Research. He is investigating the impact of HIV status upon immune suppression that results from burn injury, and examining methods of improving the outcome from burns. Additionally, in conjunction with the NC Jaycee Burn Center, Division of Infectious Diseases, Department of Surgery, and the Injury Prevention Research Center, is working with UNC faculty and Malawi health care providers to develop and implement a hospital-based trauma registry. This includes designing the collection tool and database, validating the registry data, and examining different trauma scoring systems in the context of triage and management decisions. The team hopes to apply the results to the development of an injury prevention initiative.

Adesola Akinkuotu

Adesola Akinkuotu, a rising fourth-year medical student, has received funding from the Doris Duke Charitable Foundation to work with Dr. Samuel on the injury prevention project, which aims to define the epidemiology of trauma in Lilongwe, and to implement injury prevention projects based on results from the initial part of the project. She will also be working with Dr. Mina Hosseinipour, MD, clinical director of UNC Project, on a prospective study looking at HIV positive patients on ART therapy who are admitted to the hospital. This study will study the common reasons for admission to the hospital in this patient population and the outcomes of hospital stays.

Emily Roemer

Emily Roemer has just completed her first year of medical school at UNC. This summer, with the help of the Malawi Summer Institute, Emily's research will ultimately help the Malawi Ministry of Health in evaluating their ART program. In Malawi, nearly one million people are infected with HIV, which is approximately 14% of the adult population. In 2001 the Malawi Ministry of Health initiated an ART program which has started over 140,000 people on treatment. While program participation is high, its impact on the quantity and spectrum of HIV-related admissions has not been thoroughly evaluated. Emily will perform a retrospective chart review to characterize hospitalizations of patients to the adult medical ward of Kamuzu Central Hospital in Lilongwe.

Megan Jordan

Megan is a 2nd-year medical student whose summer research in Malawi involves working with the community department at UNC Project. The community department is made up of a group of employees who follow study participants and trace patients who are lost-to-follow-up. She is currently redesigning the tracing form and tracing database that the UNC Project uses to locate study participants in the community, in order to better capture information on reasons for non-compliance with study visits and procedures. The new form and database will hopefully more accurately collect geographic and demographic data about study participants. She is performing some retrospective quantitative and qualitative analysis of patient demographics and study retention by occupation, location, and marital status.

Megan received funding from the UNC School of Medicine for her research.

Maureen Braun

(Coming soon...)