Published in the Spring 2012 Carolina Public Health Magazine
By Whitney L.J. Howell
Identifying proper treatments for eradicating infectious diseases is often “the easy part.” The hurdle is to deliver effective prevention protocols to affected populations. UNC public health researchers are overcoming this challenge with some of the world’s most contagious viruses.
Malaria
Malaria causes almost a million deaths per year. Around 30 percent of adults in the Democratic Republic of the Congo are infected with malaria, according to epidemiology professor Dr. Steve Meshnick. Meshnick has worked closely with UNC geography professor Dr. Michael Emch to map the disease and identify factors responsible for its geographic spread. Read more about Meshnick’s work at
www.sph.unc.edu/cph/tropical_disease.
SARS
Airborne viruses are also dangerous. A National Institutes of Health (NIH)-funded team led by epidemiology professor Dr. Ralph Baric investigates why SARS infection is more lethal among individuals over age 50. Using a mouse model, the team tests how new vaccine platforms induce robust protective immunity in older adults. Furthering their work, Baric and a team from UNC and Vanderbilt University have reconstructed synthetically the bat variant of the SARS coronavirus that caused the SARS epidemic of 2003. “By reconstructing the synthetic bat SARS virus, we have a model that will allow us to design better vaccines and drugs that will treat any strain of this virus that infects humans,” Baric says.
HIV prevention in Africa
Africa’s HIV statistics fueled Dr. Frieda Behets’ interest in reducing mother-to-child transmission of the virus.
In the Democractic Republic of the Congo (DRC), Behets’ PEPFAR*-funded team trains HIV-positive mothers as lay counselors. The counselors teach pregnant women who have HIV how to use treatments that prevent virus transmission to their infants. It is significant, Behets says, that the number of HIV-positive women contacting the community lay counselors is increasing. Her research shows that pregnant women with HIV are twice as likely overall not to return to clinics, where they could receive antenatal treatment, delivery support and postnatal care. Those who interact with lay counselors are more likely to utilize the clinics. Behets’ team helps train an interdisciplinary group that works in 44 maternities and two treatment centers in Kinshasa, DRC.
Dr. Suzanne Maman also studies whether prenatal and postnatal counseling with the same nurse prevents mother-to-infant transmission or new infections. In a five-year, 1,500-woman study in South Africa, Maman’s team examines how counseling may have affected infant feeding, contraception use and HIV testing.
Dr. Audrey Pettifor studies whether giving South African adolescent girls and their families a monthly cash transfer equivalent to $10 per month, conditional on school attendance, prevents HIV infection. The 2,900- girl randomized controlled trial will follow young women and their parents/guardians over three years to look at the impact of the program on HIV incidence.
“The theory is that keeping girls in school will reduce their risk of HIV infection,” Pettifor says. “There are many ways that schooling may be protective for young women, but providing money to them also may be protective.” Although study results will not be available until 2015, Pettifor says cash transfers seem to be a promising intervention. A study published in The Lancet on Feb. 15, for which she wrote a commentary (
http://tinyurl.com/lancet-commentary), found cash transfers reduced HIV risk.
In a two-year, NIH-funded study, Maman’s team implemented microfinance interventions in “camps” in Dar es Salaam, Tanzania, where 15- to 19-year-old males socialize. By giving 19 men $100 loans each, researchers tested whether professional goals would deflect men from risk-taking behaviors. Although there were too few participants in this pilot study to determine impact upon behaviors, a positive outcome was that the majority of the men have repaid their loans.
Dr. Sharon Weir participates in the USAID-funded MEASURE Evaluation project based in UNC’s Carolina Population Center. She helps establish international guidelines to monitor and evaluate HIV programs for gay men, transgendered individuals, sex workers and intravenous-drug users.
“These groups suffer from stigma and inadequate access to prevention services,” Weir says. “Guidelines give countries and providers tools to track coverage and identify gaps in information, counseling and treatment access.”
HPV
Human papillomavirus (HPV) is the main cause of cervical cancer, which remains the leading cause of cancer death among women in many countries in Africa. HIV-positive women are at a notably higher risk, says Dr. Jennifer S. Smith. Using PEPFAR* funding, her team works in Kenya and South Africa to increase cervical cancer screenings, particularly among HIV-positive and higher-risk women. Smith and Dr. Noel Brewer are leading programs to eradicate cervical cancer in North Carolina and in the U.S., too.
“HIV-positive women with a lower count of CD4 cells (a type of white blood cell) have a higher risk of high-grade cervical lesions that are more likely to lead to cancer,” Smith says. “That’s important when thinking about increasing screening for HIV-positive populations.”
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June 6, 2012
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Education, Healthcare, Profiles | Audrey Pettifor, cash advances to keep girls in school to prevent HIV infection, Democratic Republic of Congo and malaria, Frieda Behets, HIV-positive women at great risk for HPV infection, HIV-positive women in Congo less likely to seek prenatal care, identifying factors responsible for spread of malaria, international guidelines for HIV programs for gay men transgendered individuals sex works intravenous drug users, Jennifer S. Smith, loans to prevent HIV infection in Tanzania, Michael Emch, microfinance interventions in Dar es Salaam, mother-to-child HIV transmission, Noel Brewer, nurse continuity to prevent mother-to-child HIV transmission, PEPFAR funding for HPV research in Kenya and South Africa, preventing HIV infection in South African girls, preventing mother-to-child HIV transmission, preventing mother-to-child HIV transmission in the Democratic Republic of Congo, preventing spread of HPV, preventing spread of human papillomavirus, preventing spread of malaria, Ralph Baric, SARS coronavirus, SARS infection more dangerous in people over 50, Sharon Weir, Steve Meshnick, Suzanna Maman, synthetic reproductions of SARS, training HIV-positive mothers to be lay counselors, UNC Carolina Population Center, University of North Carolina at Chapel Hill Gillings School of Public Health preventing infectious disease, USAID MEASURE Evaluation project, using bat SARS virus to create vaccine |
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Published in the Spring 2011 Carolina Public Health Magazine
By Whitney L.J. Howell
Even without engaging in risky behaviors, young girls and women who live in South Africa have a 1-in-3 chance of contracting HIV.
Audrey Pettifor, PhD, assistant professor of epidemiology at UNC Gillings School of Global Public Health, launched a study in March 2011 to examine the factor known to have the greatest impact on reducing HIV infection risk – education. Pettifor partners with University of the Witwatersrand researchers Catherine MacPhail, PhD, and Kathleen Kahn, MD, PhD.
Audrey Pettifor, Ph.D., assistant professor of epidemiology at the UNC-Chapel Hill Gillings School of Global Public Health
“We know young girls who finish high school are four times less likely to become infected with HIV than those who don’t complete school,” Pettifor says. “Condom use and number of partners simply don’t explain the high levels of HIV infection we observe in young South African women.”
To keep girls in school, Pettifor and her team will randomize 2,900 young women and their parents/guardians to receive a monthly cash transfer, based on whether they attend school 80 percent of the time over the next three years. Then, they will determine whether girls receiving the cash transfers are less likely than girls in the control group to become infected with HIV.
The study, funded by the National Institute of Mental Health and the National Institutes of Health’s (NIH) HIV Prevention Trials Network, also will measure HSV-2 (genital herpes), sexual behavior, mental health, school outcomes, socio-economic status and other key social factors. It is referred to locally as Swa Koteka, which means “it is possible” in the native language, Shangaan.
Educating girls is only half the battle, however, Pettifor says. Cultural norms that impinge upon a woman’s right to resist sex or insist on condom use also have to change if young women’s HIV risk is to be decreased. Therefore, half of the young women’s villages also will be randomized to receive an intervention focused on changing negative gender norms and HIV risk among men ages 18 to 35. The team partners with a local nongovernmental organization, Sonke Gender Justice, which aims to challenge and reshape negative gender norms in South Africa.
Pettifor also directs two NIH-funded pilot projects in Lilongwe, Malawi, to help those with acute HIV infection (AHI) lessen the likelihood of transmission. AHI is a highly infectious phase of the disease.
One of Pettifor’s projects, co-led with Amy Corneli, PhD, of FHI,* will compare the effect of four intensive counseling sessions in the first two weeks after AHI diagnosis to standard counseling in reducing transmission risk to partners.
In the second project, co-led with Bill Miller, MD, PhD, UNC associate professor of epidemiology and medicine, Pettifor’s team will compare effects of three interventions – antiretroviral treatment for the first 12 weeks after infection, in combination with intensive alone and standard counseling.
“This is a behavior change intervention through which we’re asking people to change behavior for a defined and short period of time,” Pettifor says. “If we get them through this really risky time, then we can talk about a longer-range risk reduction plan.”
To read the story online: http://www.sph.unc.edu/images/stories/news/cph_2011_spring/documents/howell_HIV.pdf
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June 2, 2011
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Healthcare | Amy Corneli, antiretroviral treatment within 12 weeks of HIV infection, Audrey Pettifor, Bill Miller, Catherine MacPhail, educating South American women about HIV, effect on high school education on contracting HIV, empowering South African women to demand condom use, Family Health International, FHI, HIV counseling, HIV project in Lilongwe, HIV risk for women in South Africa, HIV risk in South Africa, HIV risk of South African men age 18 to 35, HSV-2 genital herpes, Kathleen Kahn, keeping South African girls in school to reduce spread of HIV, Malawi, National Institutes of Health HIV Prevention Trials, Shangaan, Swa Koteka, University of North Carolina at Chapel Hill Gillings School of Global Public Health, University of Witwatersrand |
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Whitney Palmer 