My primary research interests are related to international health, specifically in infectious diseases. After completing a residency in Internal Medicine at the New York Presbyterian Hospital, I spent two years as an Epidemic Intelligence Service (EIS) officer in the Foodborne and Diarrheal Diseases Branch in Atlanta. My work at the CDC included research in acute and chronic typhoid fever in Vietnam, prevention of Helicobacter pylori infection in rural Bolivia using a clean water intervention in the home, cholera outbreak investigation in the Marshall Islands and various food and waterborne outbreak investigations in the US and around the world. Following a three-year Infectious Disease fellowship at NYU School of Medicine, my research focus has been on HIV disease in Kenya. My current research focus is on the vaginal microbiome and its impact on markers of HIV susceptibility in women.
Our activities in Kenya have three components:HIV treatment, training and research.
Scale-up of HIV treatment in Kenya:
Building a workforce and infrastructure for treatment and research
I received a Presidential Emergency Plan for AIDS Relief (PEPfAR)-funded grant through the CDC with a goal of scaling up HIV treatment in a non-governmental clinic in Mombasa, Kenya, called Bomu Medical Centre. In 2004 when we started, there were a handful of patients with HIV receiving antiretroviral therapy. As of December 2011, more than 22,000 HIV-infected patients receive care there. In 2005, we initiated a new Pediatric HIV program and in 2011, 3,551 children with HIV receive care, including 1,072 who are on HIV treatment.
As part of this expansion, we built a 22,000 sq ft addition to Bomu Medical Centre, to house a new pediatric and adult HIV clinic, antenatal clinic, youth education centre and an NYU research laboratory. This was supported through many private donors and foundations.
Training and research:
Through funding from the Gilead Foundation, we have ongoing support for training and research at Bomu Medical Centre. We emphasize training in both clinical and translational research by providing didactic and hands-on training in immunology, HIV clinical research, and data management. We have completed multiple operational research projects related to screening protocols for TB, screening and risk factors for peripheral neuropathy and assessing affordable technologies for HIV viral load monitoring and early infant HIV diagnosis. Active participation by NYU undergraduate students, medical students, residents, fellows and faculty have enriched the NYU-Kenya Global Health Initiative.
Women constitute 60% of HIV-infected adults living in Africa where transmission is predominantly through heterosexual intercourse. Therefore a better understanding of the female genital tract environment that influences susceptibility to HIV and other sexually transmitted diseases is critical to developing new HIV prevention strategies.
The following are active projects in our lab with collaborations with University of Washington, University of Maryland and Bomu Medical Centre:
- An effective behavioral intervention to reduce intravaginal practices among HIV-1 uninfected Kenyan women
- The vaginal microbiome and immunomucosa of HIV-uninfected Kenyan women
- The impact of cervico-vaginal fluid on anti-HIV activity in HIV-uninfected Kenyan women