- Accelerating Strategies for Practical Innovation and Research in Economic Strengthening (ASPIRES)
- Assessment of Capacity to Prevent & Manage Major Non-Communicable Diseases (NCDs) in Primary Care Centers in Zambia: A Health Systems Approach
- Engaging Indigenous Organizations to Sustain HIV/AIDS program in Nigeria
- HIV Cervical Cancer Prevention
- HIV Prevention Trials Network (HPTN)
- HIVQUAL International HRSA/AIDS Institute New York State
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)
- Hydroxyurea for Stroke Prevention in Children with Sickle Cell Disease in Sub-Saharan Africa
- IeDEA Network Coordinating Center (INCC)
- Monitoring and Coordinating Personal Protective Equipment (PPE) in Healthcare to Enhance Domestic Preparedness for Ebola Response
- Multi-Component HIV Intervention Packages for Chinese MSM - Special Emphasis Panel Methods for Prevention Packages (MP3II)
- Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART)
- Optimizing Integrated PMTCT Services in Rural North-Central Nigeria
- Primary Prevention of Strokes in Nigerian Children with Sickle Cell Disease
- Phylogenetic Characterization the HIV-1 Epidemic in Middle Tennessee, CFAR Supplement
- Regional Prospective Observational Research for TB (RePORT)-Brazil
- Scaling Up Comprehensive Positive Prevention in the Republic of Mozambique
- Technical Assistance to The Ministry of Health (MOH) for HIV Services and Program Transition in Zambezia "Avante 1"
- WHO multi-country assessment of progress in child survival in the Africa region
- Women’s Mobility and the Continuum of HIV Care in South Africa
- Identifying Innovative Bacterial and Host-Mediated Biomarkers of Treatment Response to Tuberculosis Chemotherapy "RePORT SA"
Education and Training
- AIDS International Training and Research Program (AITRP)
- Clinical and Translational Research Training in Northern Nigeria
- Fogarty International Clinical Research Scholars & Fellows (FICRS-F) Program
- The Medical Education Partnership Initiative (MEPI)
- Partnership for Research in Emerging Viral Infections-Sierra Leone (PREVSL)
- University of Guyana Master of Public Health Programme
- Vanderbilt NARI-NIE Informatics Training Program
- Vanderbilt-Shanghai Chronic Disease Research Training Program (VU-Shanghai CDRTP)
- Vanderbilt Training Program in Molecular and Genetic Epidemiology of Cancer (MAGEC)
- Vanderbilt-Zambia Network for Innovation in Global Health Technologies (VZNIGHT)
Global Health Informatics
- Health Informatics Training and Research in East Africa (HI-TRAIN) Norad
- HIS Evaluation Framework for CDC project HQ Building Effective Health Information Systems under PEPFAR CDC
- Strengthening Mozambican Capacity in Strategic Information Systems under the President´s Emergency Plan for AIDS Relief (PEPFAR) CDC-GAP
Research Programs in Global Health: Cancer Control in Central America
The Central America Four (CA-4) LMIC Region
The Central America Four region (“CA-4”: Honduras, Nicaragua, El Salvador, Guatemala) is a core low middle income country (LMIC) region in Latin America and the western hemisphere. The CA-4 population is approximately 36 million, and directly linked to nearly 5 million U.S. immigrants. The CA-4 nations are interconnected by geography, history, language and poverty. In 2006, the CA-4 opened their borders, similar to the European Union, and has been in transition towards a union of many aspects of their infrastructures. This policy includes their health systems, with an appreciable flow of patients across borders.
The human development indices (HDI) in the CA-4 rank among the lowest in the western hemisphere, 0.606 versus 0.915 in the U.S. Available data suggests that multidimensional poverty approaches 20%. An important challenge for health programs, as well as NCD and cancer control initiatives, is that nearly half (48%) of the CA-4 population live in rural areas. Lastly, the mean health sector and public health expenditures are low, ranging from 6.5-8.6%, compared with those in Costa Rica (9.9%) and the U.S. (17.1%).
Notably, the CA-4 countries account for a large number of recent immigrant populations to the U.S., which makes the region unique among global LMICs from a U.S. perspective. A number approximately equivalent to one quarter of the population of El Salvador lives in the U.S., the majority of whom are foreign-born. From the U.S. viewpoint, the research and prevention initiatives in the CA-4 may be informative for the U.S. Hispanic population, particularly for those from the region (over 4.5 million).
Central America Four Region
Importance of CA-4 Nations and a Regional Approach
• Core LMIC region of the western hemisphere
• Region united by history, language, culture, and poverty
• Regional integration with open borders in 2006 (~EU)
• CA-4 population is >36 million
• Linked to nearly 5 million U.S. Hispanics
• At-risk population for Cancer & NCDs: >40 million
Vanderbilt research and teaching partners
• CA-4: COMISCA, INCAP
• Honduras: Ministry of Health (MOH), CAMO
• Nicaragua: UNAN-León, HEODRA, MINSA
• El Salvador: MINSAL, ASAPRECAN
• Guatemala: INCAP, INCAN, Wuqu’ Kawoq
Overview of Research Programs
Global Health and Gastric Cancer Epidemiology in Central and Latin America (2002-present)
Honduras gastric cancer molecular epidemiology and prevention initiative (2002-present)
- Focus: Population-based, gastric cancer epidemiology program
- Sites: Ministry of Health (MOH), Western Honduras (Copán) and Siguatepeque
Nicaragua global health and gastroenterology epidemiology programs (2003-present)
- Focus: Gastric cancer and gastrointestinal disease epidemiology
- Site: University of Nicaragua, León (UNAN-León)
El Salvador national gastric cancer program (2011-present)
- Focus: National gastric cancer epidemiology study and cancer control programs
- Site: Ministry of Health (MINSAL), San Salvador
University of Puerto Rico, Comprehensive Cancer Center (2014-present)
- Network linking gastric cancer epidemiology and chemoprevention research
Latin America H. pylori and Gastric Cancer Consortium (2006-2013)
- Focus: H. pylori eradication RCT and prevention initiatives
- Sites: Honduras, Nicaragua, Colombia, México, Costa Rica, Chile
Gastric Cancer chemoprevention Clinical Trials
Chemoprevention of gastric carcinogenesis in high risk populations (2014-present)
- Focus: Eflornithine (DFMO) in gastric intestinal metaplasia, Phase IIb RCT
- Sites: Honduras, Colombia
Gastric carcinogenesis prevention in high risk populations (2016-present)
- Focus: Curcumin in gastric premalignant lesions, Phase IIa RCT
- Sites: Puerto Rico, Honduras
Cancer Control and Cancer Registration initiatives in the Central America Four (2013-present)
LMIC programs and research in cancer informatics and registration (2013-present)
- CA-4 region: Honduras, El Salvador, Nicaragua, Guatemala
Technology and Endoscopy Research
- Ultra-low cost endoscopy technology for LMIC gastric cancer screening (2012-present)
- Novel technologies in endoscopy imaging for LMIC point-of-care testing (2016-present)
Overview of Research and Education Partners
- Hospital de Occidente, Ministry of Health, Santa Rosa de Copan, Honduras
- Central America Medical Outreach (CAMO)
- National Autonomous University of Nicaragua-León (UNAN-León)
- Hospital Escuela Oscar Danillo Rosales Arguello (HEODRA), León, Nicaragua
- El Salvador Ministry of Health (MINSAL)
- Salvadorian Association for Cancer Prevention (ASAPRECAN), El Salvador
- Institute of Nutrition of Central America and Panama (INCAP)
- Wuqu’ Kawoq Mayan Health Alliance
- Universidad del Valle (UdV), Guatemala
- Primeros Pasos
- Moore Pediatric Surgery Center
- Universidad del Valle, Cali, Colombia
- University of Puerto Rico, Comprehensive Cancer Center
Vanderbilt University Collaborators
- Division of Gastroenterology, Hepatology and Nutrition
- Center for Latin American Studies
- School of Medicine
- School of Nursing
- School of Engineering
Vanderbilt Opportunities for Student Engagement in the CA-4:
Troy Moon, M.D., M.P.H.
Jahit Sacarlal, M.D., M.P.H., Ph.D.
Wilson Pereira Silva
Bacteremia in HIV-infected Children Under 5-years-old Hospitalized in Mozambique (R01AI12295-04)
We propose a prospective hospital-based observational study of HIV-infected children <5 years old in Mozambique to determine the incidence, etiology, antibiotic sensitivity patterns, and molecular characterizations of culture confirmed bacteremia. Our study holds promise to illuminate rural/urban health disparities that can then be targeted for mitigation. The results of this project will provide crucial but currently unavailable information to prioritize resource allocation for microbiology capacity and guide national drug formulary practices.
Carolyn Audet, Ph.D.
Traditional Healers as Adherence Partners for PLHIV in Rural Mozambique (K01MH107255)
This career development award application seeks to foster the advancement of the applicant's career as an independent HIV/AIDS researcher with a research focus on developing effective strategies to engage the army of community health workers - including traditional healers and traditional birth attendants - as adherence partners, referral agents, and educators. The goal of Dr. Audet's research is to improve health outcomes among rural community members who seek alternative care and treatment for illness, specifically those with chronic disease, including HIV/AIDS, with a geographic focus in Mozambique.
Aimalohi Ahonkhai, M.D.
Decreasing Interruption & Losses from HIV Care in Nigeria (K23 AI106406-04)
Both loss to follow-up and unplanned care interruption from HIV care are of critical public health importance as they are each associated with substantial morbidity and mortality, negating the gains in life expectancy provided by antiretroviral therapy. The proposed research, focused in a large multi-site HIV treatment program in Nigeria, will identify novel factors that influence patient decisions and outcomes related to adherence to HIV care over time.
Charles R. Horsburgh, Jr., M.D.
Timothy R. Sterling, M.D.
Predictors of Resistance Emergence Evaluation in MDR-TB Patients on Treatment (PREEMPT) (R01AI134430-01)
Multi-drug-resistant tuberculosis (MDR-TB) affects over 500,000 persons each year around the world and many patients die from it. During treatment, some patients discover that the germs with which they are infected have developed resistance to some of the antibiotics they are taking. The purpose of this study is to determine why this happens and to identify ways that this could be prevented.
Troy Moon, M.D., M.P.H.
This Nutrition baseline assessment (cross-sectional survey) will generate baseline information on nutritional status of under-five children in targeted districts and within the wider provinces of Nampula and Zambezia in year one of the implementation of a multi-years EU programme. The surveys will also include indicators related to knowledge, attitudes, behaviors and practices and will generate findings on breastfeeding and complementary feeding practices, improved water access, hand-washing, hygiene, particularly related to the first 1,000 days, and sanitation practices. Additional areas of interest are knowledge, attitudes and practices related to a range of maternal and child health interventions and behaviors. These will inform progress towards UNICEF's country programme 2017-2021 plan. Results will serve as baseline information against which progress will be measured after 3 and 5 years. In addition survey results will be disseminated through workshop to the districts and provinces targeted. Results will also be used to develop policy briefs and district and provincial nutrition profiles which will be used for advocacy purposes with the aim of increasing awareness and leadership among provincial and districts level stakeholders in all relevant sectors.
The nutrition program of UNICEF Mozambique will focus in Zambezia and Nampula, the two provinces with the highest burden of malnutrition and will specifically aim to contribute to the government five-year plan to reduce stunting among children under-five· to 35% by 2020 and achieve the six maternal, infant and young child nutrition targets of the World Health Assembly.
Community I-STAR Mozambique: Community Implementation of SBIRT using Technology for Alcohol use Reduction in Mozambique
Hazardous drinking is a major public health burden worldwide with significant morbidity and mortality. Community I-STAR Mozambique will examine the implementation and effectiveness of two different strategies to train and supervise community health workers in Mozambique to sustainably provide community-based services to reduce hazardous drinking. The first strategy is Screening, Brief Intervention, Referral to Treatment (SBIRT), which utilizes mobile health technology. The second strategy will involve traditional training and supervision. Working with the Research Foundation for Mental Hygeine, Dr. Audet is responsible for providing assistance in study design, implementation, and training for fellows. This study will leverage existing platforms and participation of policy makers ready to apply and sustain evidence-informed policies over time, and it will inform policy decision-making and clinical practice not only in Mozambique but also in many other low- and middle-income countries.
Young Kim, Ph.D., M.S. and Martin Were, M.D., M.S.
Laboratory test-comparable mobile assessments of hemoglobin for anemia detection (R21TW010620-01)
Anemia, which is defined as a decrease in the amount of hemoglobin in the blood, is a major public health problem in low- and middle-income countries. However, portable/point-of-care hemoglobin measurement modalities often remain inaccessible/unaffordable and current noninvasive mobile-based technologies still lack sensitivity/specificity for different levels of anemia. In this respect, we will develop mobile smartphone-based noninvasive hemoglobin analyzer (mHema), implement a user-friendly application in conventional mobile smartphones, and evaluate the accuracy and precision of mHema in low-resource settings.
The Clayton-Dedonder Global Health Mentorship Fellows Program (CD) is a mentorship and training program awarded to the University of Zambia (UNZA) and its institutional partners. This fellowship will utilize and build upon the existing UNZA-Vanderbilt Partnership for HIV Nutrition-Metabolic Research Training (UVP) program by designing and implementing a Ph.D. mentoring program. The CD Fellowship will support intensive mentorship training to strengthen the UNZA Ph.D. Program under the UNZA College of Medicine to enhance its capacity to train future researchers.
The intensive mentorship and leadership training program will both train junior faculty members and engage senior faculty members to hone their mentorship skills. Both senior and junior groups will comprise all Ph.D.-training disciplines at UNZA. Two core principles will guide this capacity building approach. First, senior UNZA faculty will lead the curriculum development process to facilitate context-appropriateness, ensure sustainability, enhance their knowledge, and hone their mentorship skills. Second, the IHI Collaborative Model will serve as a framework for curriculum development, implementation, and evaluation.
Overall, this program will support UNZA to establish and grow its Ph.D. mentor training program for the College of Medicine's four schools (Medicine, Public Health, Health Sciences, and Nursing), train 10 Clayton-Dedonder fellows in mentorship of UNZA Ph.D. students and use an iterative evaluation model to optimize the training program and integrate it as a required component of the UNZA Ph.D. Program.
The Clayton-Dedonder Global Health Mentorship Fellows Program is funded by Fogarty as part of its effort to strengthen HIV/AIDS research training in low- and middle-income countries. UNZA is one of six organizations to receive this funding.
In collaboration with Lwala Community Alliance, VIGH is developing and implementing a population-based survey for the North, East, South & Central Kamagambo wards of Rongo sub-county, Kenya. The implementation plan includes data and statistical analysis, and technical support. In addition, to providing a sampling frame, other support includes oversight of Vanderbilt MPH student thesis and manuscript generation.