Current Issue, Faculty, Research, Winter 2018 0

The Trust Network

When it comes to establishing a network of trust, Brown researchers know that community building is essential.

BUILDING TRUST TAKES TIME

So-called “helicopter research,” “parachute research,” or “drive-by research” occurs when researchers drop in to communities, and then quickly leave. Members of already marginalized communities can be made to feel used, intimidated, and even suspicious of researchers’ goals. Researchers in the Brown University School of Public Health take a different approach. They know that when community members are engaged in the process, researchers not only gain their trust, but are able to gain deeper understanding of prevailing health behaviors and formulate more nuanced approaches to improving them.

Making long-lasting commitments to the communities in which they work is a hallmark of the global health researchers in the School of Public Health. Their work is collaborative by nature and often community-based, relying on the buy-in and input of community members. While it often takes years to build community trust and understanding, partnered approaches can lead to innovative research. One example is Caroline Kuo’s project applying a resilience-oriented, family-based approach to preventing HIV among South African adolescents. Professor Stephen McGarvey is an example of a faculty member who has dedicated his career to a particular people. What he has learned benefits the Samoan people directly, while it informs our larger understanding of obesity trends around the world. Here are snapshots of some of the current global research projects now underway.

LATIN AMERICA
  • What happens if you pay members of populations at very high risk of contracting or spreading HIV to engage in risk-reducing behavior? Professor Omar Galárraga explores the potential effectiveness of economic incentives, and other behavioral economics innovations, to prevent and treat HIV and other chronic conditions in Mexico City. His findings suggest that incentives can reduce risky sexual behavior and improve rates of engagement with healthcare services.
  • What are the factors that prevent Brazilian youth from accessing antiretroviral therapy, the medication that controls HIV? Professor Matthew Mimiaga is conducting formative research with community advisory board members, key informants, and HIV infected adolescents in Rio de Janeiro, Brazil to inform a behavioral intervention for improving adherence to antiretroviral therapy among this population. The resulting counseling- and technology-based HIV medication adherence intervention package will address inequalities among diverse ethnicities, sexual and gender minorities, and classes by addressing the structural (e.g., transportation to clinic visits, perceived healthcare discrimination) and individual-level (e.g., social support, psychosocial problems) barriers to adherence faced by many adolescents in this setting.
  • Professor Mimiaga is also engaged in a social network-based intervention to promote PrEP adherence among transgender women at risk for HIV infection in Lima, Peru. PrEP (Pre-exposure prophylaxis) is a highly effective daily medication that lowers the chance of HIV infection. In addition to daily PrEP, the intervention includes individual counseling, group workshops, and social network interactions. Once the intervention is developed, a pilot test will be conducted by randomizing social network-based clusters of transgender women.
ASIA
  • Professor Simin Liu’s research responds to the emerging health threats from the vast environmental pollution and deterioration in China. He is building a prenatal cohort study and a birth cohort study in Wuhan, China to test the “fetal origin” hypothesis for human diseases.  The fetal origin hypothesis suggests that human diseases start in utero, because fetuses are most sensitive to environmental exposures. He aims to follow women and their children from prenatal to postnatal, and to investigate factors related to pregnancy outcomes, birth outcomes, and health outcomes of children later in life.
  • Professor Liu also studies the environmental exposures of workers in China. His cohort study of the Kailuan Coal Industry in Hebei, China includes 100,000 coal miners and has followed the subjects every two years to study coal miners’ health from occupational exposure to coal dust. The Jingchuan Metal Exposure Cohort Study in Gansu, China involves 50,000 workers exposed to nickel, copper, cobalt, zinc and other heavy metals.  The study has followed the subjects every two years by interviewing and collecting blood samples to study the effect of heavy metal exposure on human health, including incidence of cancer, cardiovascular disease, and metabolic disease.
  • Two Public Health students are examining the burden of behavioral and psychological health problems that contribute to morbidity and mortality in South Korea. Doctoral student Harold Lee is studying the socioeconomic disparities associated with physical activity, while Master’s student Yoojin Cha is examining the prevalence and intersections of mental health, alcohol, and smoking. They are analyzing the Korean National Health and Nutrition Examination Survey, a national representative study of adults in South Korea.
  • Transmission of HIV through sex has been rising exponentially in China. Professor Don Operario is engaged in a trial that uses mobile health (mHealth) approaches to promote HIV self-testing with high-risk men in China. Using WeChat, the most popular social networking app in China, his team developed an mHealth intervention that supports high-risk HIV uninfected men in administering HIV self-testing, interpreting results, engaging in regular repeat testing, and reducing risk behavior. This is the first known attempt to develop a combination approach to HIV self-testing (HST) that leverages advances in mobile technology as a platform for repeat testing and motivating behavior change. The findings will support future testing of the effectiveness of a combined HST plus app-based messaging intervention on sexual risk behavior and HIV retesting.
AFRICA
  • South Africa suffers the world’s largest HIV epidemic. Professor Caroline Kuo is taking a resilience-oriented approach to preventing adolescent HIV/STI infection and depression. Her international team will examine the efficacy of a family-based preventive intervention for adolescents and their caregivers.
  • In 2010, 30.2% of all pregnant women in South Africa who attended public sector health-care facilities were infected with HIV. Healthy Moms, Healthy Families is a longitudinal qualitative study by Professor Jennifer Pellowski that aims to develop and test a bio-behavioral intervention that capitalizes on the transition into motherhood to bolster self-care behaviors and increase HIV treatment adherence among pregnant and postpartum women in Cape Town, South Africa.
  • Professors Abigail Harrison and Caroline Kuo are researching the health needs of the first generation of adolescents living with HIV in South Africa as they transition to adulthood. Their study is focused on this high-priority population’s social and reproductive health needs, as well as the barriers and facilitators to adherence for anti-retroviral therapy, and the development of innovative interventions to promote a health-enabling environment.
  • Migration, Urbanization and Health in a Transition Setting is a study led by Professors Mark Lurie and Stephen McGarvey that examines the contemporary health transition in South Africa to better understand, at the individual level, how a complex pattern of migration and urbanization helps drive the health transition in these settings. The study devotes particular attention to how migration and urbanization help determine both risk factors for health conditions, as well as access to care and treatment.
  • There were 62,000 new HIV infections in Kenya in 2016. Professor Don Operario is examining the co-occurrence of HIV risk, mental health, and alcohol use among men who have sex with men in coastal Kenya, His goal is to develop interventions using mobile health approaches to improve access to health promotion counseling and support for this population.
  • Ghana has done well reacting to the HIV epidemic, increasing awareness and services, but many populations remain vulnerable. Professor Omar Galárraga is engaged in a collaborative project with the Komfo Anoyke Teaching Hospital and Adolescent HIV Clinic in Kumasi, Ghana to test the preliminary efficacy and feasibility of group-based conditional economic incentives to increase adherence to antiretroviral therapy among adolescents living with HIV.
PACIFIC ISLANDS
  • Professor Stephen McGarvey has spent decades studying obesity in Samoans. His latest project is an investigation of the physiologic and behavioral pathways that may underlie the relationships of a newly found gene variant with adiposity and type 2 diabetes in Samoans. At the same time, his team is using whole genome sequence data to conduct whole genome-wide association studies of adiposity and related metabolic phenotypes in Samoans.

 

INTERNATIONAL COLLABORATIONS

Long-standing collaborations are needed to build resilient capacity in developing countries with scarce resources. The School’s commitment to training local public health practitioners and researchers around the world is helping to ensure improved health outcomes for future populations.

Brown University Ukraine Collaboration
HIV/AIDS is a crisis in Ukraine. Many of the infected are young adults, who, over the next ten years will become ill with AIDS and TB, placing tremendous stress on Ukraine’s already strained healthcare system. The Brown University Ukraine Collaboration, now in its sixth year, is a joint venture between the Brown University Center for AIDS Research and HIV health and service providers in Ukraine through the support of the Elena Pinchuk ANTIAIDS Foundation. Led at Brown by Professor Timothy Flanigan, the program aims to foster effective educational collaborations in the areas of public health with emphasis on improved care and prevention of diseases that impact marginalized communities, particularly HIV, TB, and hepatitis C.

The NAMBARI Program: Moi/Brown Partnership for Biostatistical Training in HIV
The NAMBARI program responds to the critical need for capacity building in biostatistics and other quantitative sciences to support the enormous volume of HIV and health-related research taking place at Moi University, in Eldoret, Kenya. Expert statistical analysis is fundamental to generating high-quality research that informs evidence-based practices used to combat HIV. The NAMBARI program addresses the need for more highly trained Kenyan biostatisticians by expanding research and curricular capacity in biostatistics and advanced quantitative methods at Moi University, laying the foundation for development and ongoing training of a sustainable critical mass of faculty and staff scientists in this field. NAMBARI also provides graduate-level training in biostatistics at Brown University to highly qualified Kenyan candidates from Moi University, along with workshops and faculty development in Kenya. The program is led by Principal Investigator Professor Joseph Hogan at Brown.

SASH: The South African Social Science and HIV Programme
A joint project of the University of Cape Town, South Africa and Brown University, SASH is led by Professor Mark Lurie at Brown. The program enhances infrastructure and research investments at the University of Cape Town’s School of Public Health and Family Medicine. Key to these efforts are the training and mentoring of SASH fellows, young South African leaders who are learning to apply social science methods to better understand the HIV epidemic in sub-Saharan Africa. These investments will develop a new generation of rigorously trained HIV social scientists to address research questions of social science and public health importance, and to foster a culture of excellence in social science research on HIV/AIDS.

The South Africa Addiction Technology Transfer Center
The South Africa Addiction Technology Transfer Center (ATTC) reflects a strategic international partnership between the New England ATTC, one of the longest continuously operating ATTCs in the US, and the University of Cape Town, the oldest and highest-ranked University in South Africa. Its primary focus is to develop and strengthen South Africa’s national workforce to provide evidence-based integrated substance use disorder, mental health, and HIV care. Funded by a $2.5 million dollar grant from the Substance Abuse and Mental Health Services Administration, the south Africa ATTC is led by Professors Caroline Kou and Sara Becker at Brown.

HIV/TB Training Partnership with the University of Ghana
With support from the Fogarty International Center of the National Institutes of Health, Brown University professors are working with colleagues in Ghana to build the research capacity needed to address the deadly co-epidemics of HIV and tuberculosis.  This multidisciplinary research training program will train a cadre of Ghanaian scientists and researchers by supporting PhD degree candidates, master’s level, and postdoctoral trainees at both Brown and the University of Ghana.  These trainees will ultimately develop independent, high-quality research to address yet unanswered and emerging questions that could transform TB prevention and care programs for people living with HIV in Ghana. The program is led by principal investigator Dr. Awewura Kwara, professor of medicine in the Alpert Medical School at Brown University.

University of the Philippines
The Philippines is experiencing one of the fastest growing HIV epidemics in the world, yet the country lacks the research infrastructure to mobilize a strong evidence-based response. Brown is helping to build capacity for HIV behavioral-social science research in the Philippines by training HIV scientists who can respond to the epidemic. The project supports students from the Philippines in Master’s and doctoral training at the Brown University School of Public Health. Specific training will focus on HIV prevention and treatment in key populations, such as sexual and gender minorities. Brown will also host visiting scientists and postdoctoral fellows from the University of the Philippines as well as hosting annual workshops in Manila to build a curricular infrastructure related to HIV behavioral-social science research. This project is led by principal investigator Professor Don Operario with support from the Fogarty International Center of the National Institutes of Health.

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