KU Medical Center researchers battling HIV/AIDS in Africa
July 30, 2018
By Greg Peters
While great advances have been made in treatments for HIV and AIDS, the stark reality remains that the virus is still among the leading killers in sub-Saharan Africa. In Kenya alone, roughly 6,000 babies each year become infected with the virus.
Sarah Finocchario Kessler, Ph.D., MPH, an associate professor in the Department of Family Medicine at the University of Kansas Medical Center, has spent nearly a decade traveling to Kenya looking for ways to slow the trend by reducing the number of infants infected with HIV during pregnancy, delivery or while breastfeeding. Although the mother-to-child infection rates have been dropping steadily during this time, the findings in Kessler's recently completed R01 grant may be a game-changer for HIV-positive mothers and their children living in countries with limited resources.
By using a web-based tracking system created by a nonprofit organization to monitor time-sensitive medical interventions, researchers were able to show a marked improvement in the delivery of HIV services to their study participants, thus raising the chances of survival. These results open the door for this tracking system to improve HIV care throughout Africa and beyond.
"This high-impact public health work has the potential to improve maternal and pediatric services for millions of families in Kenya and throughout Africa," said Kessler, who has led four National Institutes of Health-funded grants in Africa. "It has been incredibly rewarding to be part of this team effort, working with so many passionate and committed people, especially our team members in Kenya."
It's a HIT
Gaps in daily communications have proven to be a major challenge in providing ongoing health care in underserved countries such as Kenya, so Kessler's team schemed to find ways technology could solve the problem. Their theory was that by strengthening channels of communication, they could raise the standard of care to meet national guidelines. This would in turn prevent people from falling through the cracks in the system, and ultimately save lives.
The team's solution for improving accountability of service delivery and consistency in communication between patients, health care providers and testing labs turned out to be the HIV Infant Tracking System (HITSystem) - a web-based program created by Brad Gautney, Kessler's former graduate school classmate at Johns Hopkins, and his nonprofit organization, Global Health Innovations. GHI designs, implements and manages medical programs, and it has been a frequent collaborator with KU Medical Center on various studies during the past five years.
To test the system, Kessler's team conducted a study at six hospitals in Kenya. At three government hospitals, they used the HITSystem to track participants, while participants from three other matched hospitals were tracked using traditional methods. Because the HITSystem can be accessed by nearly any computer or tablet via a satellite-based broadband internet connection and small, inexpensive modems, it is versatile enough for the field and the lab.
The program automatically prioritizes infants testing HIV-positive, so treatments are started immediately, maximizing the chances of survival. Normally, alerts on the program's dashboard allow health care providers to quickly identify infants who are overdue for time-sensitive testing or follow-up services. The alerts automatically trigger text messages and additional outreach as needed, ensuring connections are made. These communications help keep infants in the system until they are 18 months old - an age when they typically can be declared HIV-free.
In the study, the HITSystem group showed significant improvement in the proportion of infants completing the early infant diagnosis (EID) cascade (an array of HIV tests and possible treatments) through 18 months (85 vs. 61 percent). In addition, the study found that 100 percent of the HIV-positive infants in the HITSystem group were started on antiretroviral therapy (ART) compared to 72 percent in the control group. Testing turnaround times were also greatly improved, resulting in earlier treatments.
"Our hope is that within a year or two the HITSystem will be declared the national program for early infant diagnosis in Kenya, taking its effect to an even higher level," said Kessler.
Another benefit of the HITSystem was that the text messages sent to the mothers served as further encouragement for them to continue getting HIV care for themselves and their babies. All told, fewer families are lost in the shuffle and abandon treatments, which can mean the difference between life and death, especially for infants.
"I am originally from Kenya, so the work we are doing with the HITSystem is especially close to my heart," said Natabhona "Natty" Mabachi, Ph.D., a key part of Kessler's research team. "It is very rewarding to be part of a research team that works tirelessly to improve and save the lives of HIV-positive mothers and their babies. None of this would be possible without a partnership between the United States and Kenya that is based on amazing expertise, reciprocity and trust."
Show and tell
In early June, Kessler's team and university officials led by Chancellor Douglas A. Girod, M.D., Belinda Vail, M.D., professor and chair of the Department of Family Medicine, and Kimberly Connelly, senior international officer for the Office of International Programs, traveled to Nairobi to present their study results to the Kenyan Ministry of Health and other United States Government-funded implementing partners.
"Sharing our data with the Ministry of Health in Kenya was a big step toward the goal of a scale up and sustainability," Kessler said. "Based on the findings and growing reputation of the HITSystem, several more sites are being trained on HITS."
While in Kenya, Girod signed a memorandum of understanding with KEMRI Director Yeri Kombe, MBChB, Ph.D., MPH, and Gautney expanding research and promoting educational exchanges. KU Medical Center now has more than 80 such agreements worldwide, which serve to further its mission of providing quality health care for Kansas, the nation and beyond.
"Our partners at the Kenya Medical Research Institute (KEMRI) were honored that our chancellor would make the trip to Kenya to meet them," said Kessler. "Dr. Girod was amazing helping us brainstorm new opportunities to expand our research partnerships, including global oncology."
The story of HITSystem doesn't end here. Not only can the program save lives, it can save money. By identifying the disease early and with patients beginning treatments promptly, it appears to be cost-effective based on World Health Organization standards. The system is currently in use in more than 40 hospitals in Kenya and nearly 250 facilities in Africa, including GHI installations in Tanzania, Malawi and Nigeria, with more than 120,000 patients enrolled.
"We have also adapted the HITSystem to support services for HIV-positive pregnant women and are currently evaluating that iteration of the system," said Kessler, whose team has applied for grant renewals that would allow them to introduce the program in several additional counties in Kenya. "We are working with Gautney on a 3.0 version that follows the guidelines for clinical treatment of infants diagnosed as HIV-positive, following them through adolescence to maximize retention and survival."
In addition, Kessler and her team are among the first in Kenya to pilot new point-of-care HIV technologies for HIV testing at the time of birth.
END NOTE: Kessler credits the Kenya Medical Research Institute (KEMRI) and Children's Mercy, including her mentor Kathy Goggin, Ph.D., for helping implement, adapt and evaluate the HITSystem. In 2011, Samoel Khamadi, Ph.D., led KEMRI's efforts to partner in the research. Thomas Odeny, MBChB, MPH, a KEMRI researcher and medical resident in Kansas City, is helping to shape the team's vision for future work in Kenya.
Connelly plans to facilitate at least three more memorandums of understanding with Kenyan hospitals and county-level ministries of health. May Maloba, HITSystem director in Kenya and study investigator, is the point person in Kenya for KU Medical Center educational exchanges.