University of Virginia

Pfizer International Health Initiative

Progress Report to the Pfizer Foundation

2005

 

The Pfizer Foundation’s support of the Pfizer International Health Initiative at the University of Virginia is allowing us to fulfill our goal of building resources, resolve and capacity to meet some of the gravest healthcare and human challenges.

Under the direction of Dr. W. Michael Scheld in the Division of Infectious Diseases and International Health and building on the Center for Global Health research and administrative infrastructure, the Pfizer Initiative is advancing a new exchange program of post-doctoral fellows and students between the University and several international partners to conduct research on global health issues. The major purpose of this program is to foster and enhance bidirectional research training for treating infectious diseases like AIDS, tuberculosis and malaria.

 

2005 Pfizer International Health Initiative Fellows

With the inspiration of Pfizer supported efforts such as the Academic Alliance for AIDS Care and Prevention in Africa and the leadership of AAF member, Dr. Scheld, international and UVa-based fellows are finding the drive and the resources to make an impact on the struggle to treat and prevent devastating infectious disease. The connection of talented researchers with unique insight into the cost and debilitation of disease in the developing world and the resource-rich environment of the University of Virginia enables highly developed and highly relevant research training. 

In 2005, international fellows Samie Amidou from the University of Venda in South Africa and Dr. Gibson Kibiki from Kilimanjaro Christian Medical Center in Tanzania conducted research under the direction of UVa Medical School Faculty, Dr. Richard L. Guerrant (Center for Global Health Director) and Dr. Eric Houpt, both in the Division of Infectious Disease and International Health. UVa physician fellow, Rebecca Kightlinger initiated a multilateral effort to study the incidence of cervical cancer and HIV among Amerindian women of the remote interior in Guyana. Additional international fellows from South Africa and Brazil and an UVa-based fellow slated to work in Uganda have been selected and will begin their research in 2006. (Attachment 1)

The CGH-established fellow training program has maintained a committed focus on the research priorities of visiting fellows while engaging UVa faculty and students in areas critical to addressing endemic infectious diseases and other health threats. (Attachment 2) Far beyond the benefits to the individuals involved, this collaborative research strengthens existing relationships between UVa and institutions in developing countries and builds the capacity of all the institutions involved. We believe that investment in teaching individuals who will return to build collaborative research programs in their home institutions is the most effective way to build an interactive global health capacity on which we shall all depend.

All too often international training means providing opportunities for overseas physicians and scientists who then move permanently to the U.S. (the typical problem of the “brain drain”). The successful re-entry of Pfizer-CGH trained fellows creates further opportunities for UVa faculty and students (as well as collaborators from other institutions) to work with outstanding, well-trained colleagues in a functioning collaborative laboratory and field site abroad and to advance an already solid institutional infrastructure. While at UVa, visiting Pfizer-CGH fellows offer support to UVa students in their applications to the various scholar award programs. This support frequently consists of research-related mentoring and may extend to logistical support.

This kind of interaction with the Pfizer-CGH Scholar Award in Infectious Disease program for medical, graduate and undergraduate students from across the university provides a means for international fellows to employ their expertise and creativity in an inter-disciplinary approach to many of the health concerns they address in research.

We are expecting a new group of Pfizer-CGH fellow applications with a deadline of 1 March 2006 and look forward to offering support for additional long and short term fellowships in 2006-2007. (Attachment 3)

 

2005 Pfizer International Health Initiative Fellows Research Summaries

Gibson Kibiki: September – December 2005

Home Institution: Kilimanjaro Christian Medical Center, Moshi, Tanzania

 

Dr. Kibiki's work with Dr. Eric Houpt, UVa faculty in the Division of Infectious Disease and International Health, targets examination of tuberculosis and HIV/AIDS co-infection.

 

To date, despite a high rate of world-wide TB infection, there is little data in this area. This short-term fellowship is a springboard for an expanded collaborative relationship with Tanzania, a new publication soon to be submitted, as well as seminal preliminary data which is the basis for a new R-21 NIH grant application currently under development.

 

In his own words:

 

TB/HIV CO-INFECTION:

Correlation of cytokine levels to radiographic lesions & TB burden

 

HIV and TB

  • HIV -- a major modifying factor in TB influencing

o       Its pathogenesis

o       Its spread

o       Presentation

o       Prognosis

  • HIV -- increases risk of

o       Reactivation of latent MTB

o       rapid TB progression after (re)infection

o       poor prognosis

  • Dx of PTB with HIV is difficult  - poor sputum yield, atypical Sx and CXR

 

HIV and TB epidemiology

 

  • 1/3 -- of the world is infected with M. tb
  • HIV has increased TB burden

o       TB - most common disease a/w AIDS

o       HIV attributes up to 31% of new cases

  • By 2000

o       8.3 million new cases

o       up to 2.2 million deaths/yr

o       Sub-Saharan Africa -- the most affected region 

 

REBECCA KIGHTLINGER: November 2005-October 2006

Home Institution: The University of Virginia

 

Dr. Kightlinger is a new faculty member in the UVa Department of Obstetrics. Her project, entitled: “The Guyana Cervical Cancer and Women’s Health Program” has been awarded for 1 year. Dr. Kightlinger’s fellowship award, funded with the Pfizer International Health Initiative, has enabled UVa to open up a new collaborating site in Guyana, South America. (Attachment 4) This new collaboration will allow for an exciting interchange of students and faculty members in many areas of global health, with a specific emphasis on women’s health.

 

In Dr. Kightlinger’s own words,

 

Remote Area Medical’s (RAM) cervical cancer screening program for Amerindian women living in the remote interior of Guyana was launched in November, 2003, with screening by conventional Pap smears. Initial results indicated 59.4% of patients with cervical dysplasia and 5% with carcinoma. In April, 2005, I joined the RAM team to begin colposcopic follow-up, treatment with LEEP, and hysterectomy for patients with severe disease.

 

To date, nearly 1000 women have been screened, and thirteen women have just undergone hysterectomy for cervical disease, the first hysterectomies ever performed in the Rupununi Savannah. All patients have recovered well.

 

The incidence of HPV among Amerindian women is being researched through Thin Prep Paps with the intention of instituting an immunization program when the HPV vaccine becomes a clinical reality. Preliminary research is showing pockets of high risk patients and cervical cancer in young women (average age 22). We will further investigate these findings as results from the most recent mission become available.

 

The goal of these medical missions is to establish a sustainable Cervical Cancer and Women’s Health Program in Guyana. To accomplish this, we have forged collaborative relationships with the University of Guyana School of Medicine, Georgetown Public Hospital, the Ministry of Amerindian Affairs, Guyana’s Minister of Health, and the Pan American Health Organization (PAHO).

 

These collaborative programs, which link Medicine, Education, Research, Government, and International institutions, will form the foundation of the Women’s Health Program.

 

With the Pfizer-CGH Fellowship, my work in Guyana will be greatly assisted. The Guyana Cervical Cancer and Women’s Health Program will benefit not only the Amerindian women of the Rupununi, but indigenous women throughout Guyana. Training Guyanese medical professionals and establishing the RAM Center will raise the standard of medical care and improve the medical infrastructure throughout Guyana.

 

 

Amidou Samie: August 2005-August 2006

Home Institution: University of Venda, Thohoyandou, Limpopo Province, South Africa
 
The main objectives of my research training at the University of Virginia involve the molecular detection and characterization of major enteropathogens including Campylobacters, Entamoeba and Cryptosporidium. 
 
This involves species and subspecies determination by Polymerase Chain Reaction; phylogenetic analysis and fingerprinting methods in order to assess the genetic diversity and pathogenicity of these organisms in the Venda region of South Africa. The sequencing of the DNA gyrase, Topoisomerase, and 23SrRNA genes will be necessary in order to study the mutations and polymorphisms associated with resistance to Fluoroquinolones and Macrolides antibiotics which is a growing threat in the management of Campylobacters gastroenteritis when antibiotic use is recommended as in children and immunocompromised individuals. The aim of these investigations is to provide baseline data on the properties of these enteric pathogens in the Limpopo Province of South Africa, which could be relevant for the design of prevention strategies, antibiotic dispensation, and the evaluation of candidate vaccines necessary for the control of Campylobacters infections as well as other diarrhoeal diseases in an environment where HIV and AIDS is a huge health concern.
 
For the last three months I have isolated the genomic DNA from stool samples and used it to detect the presence of different organisms targeted in this study. A total of 244 samples have been tested. I have also attended different training sessions including Rodent handling and surgery Computer classes: Advanced PowerPoint, Using Reference Manager on Accessing Library Resources from Your Desktop Web of Science Introduction to Flow cytometry Bio-safety level III practices
 
I have been collaborating with other members of the laboratory in order to enhance my understanding on the different techniques used in the Laboratory. I have particularly experienced the Real time PCR which is the fastest amplification method. 
 
All these techniques will be used once I get back to South Africa to produce data on immunology, molecular biology and fundamental Microbiology and will be shared with other members of the Microbiology department as well as other students and staff member of the University of Venda.

 

Pfizer - Center for Global Health Scholar Award in Infectious Disease

 

The Pfizer-CGH Scholar Award in Infectious Disease promotes rigorous scholarship, innovative research inquiries and international exposure for University of Virginia medical, graduate and undergraduate students. Pfizer-CGH Scholars in Infectious Disease are engaging faculty mentors and seeking guidance from current fellows as they plan experiences in collaborating sites abroad. This scholar award is intended to foster an understanding of the social and ethical implications of health care imbalances between developed and less developed countries through the support of research with service and experiential learning opportunities. The award is a critical mechanism in the ongoing effort to encourage a future generation of health care professionals to become globally aware and socially responsible by promoting the academic and professional development of student leaders in the field of global health.


This year, with Pfizer funding we were able to fund two outstanding 1st year medical students working in Tanzania and Guatemala as well as two 4th year medical students who are now beginning their research investigations in Uganda and Peru. (Attachment 5)

In addition, the Pfizer Initiative has partnered with existing scholar programs designed to provide international clinical experiences in the treatment of infectious disease to advanced medical students.  Medical, MPH and undergraduate students have benefited tremendously from the assistance of the Pfizer International Health Initiative. (Attachment 6) Moreover, the students who seek out these awards and meet the selection criteria are educated in a variety of disciplines such as biology, neurology, psychology, economics, and foreign affairs prior to their pursuit of medicine. They are highly focused, motivated, and committed to global health.

New scholar applicants who are pursuing other scholarship awards at the University of Virginia are seeking mentorship from Dr. Scheld and opportunities at the Infectious Disease Institute in Uganda.  Highly motivated, talented students are seeking involvement in the global response to HIV/AIDS. As with the fellows sustained by the Pfizer Initiative, this benefit extends beyond the time of the award and the work of individuals. Students participating in these experiences are often changed markedly and their subsequent academic and professional activities are invested with a commitment to global health.

Additional Activities

 

In October 2005, the Center for Global Health teamed up with the International Medicine Club and the local chapter of the American Student Medical Association to present the “First Annual Medical Student Global Health Symposium”. (Attachment 7) Twenty-three students presented posters and three students gave oral presentations. Dr. Nathan Thielman, Assistant Professor of Medicine and Medical Director of the Infectious Disease Clinic at Duke University gave the keynote presentation. This symposium gave medical students and faculty the opportunity to highlight their dedication to global health.

 

Dr. Thielman is a former University of Virginia fellow in Infectious Disease; 2005 Pfizer-CGH Scholar and IMC president, Alex Hawkins, met Dr. Thielman while working at the Kilimanjaro Christian Medical Center in Moshi, Tanzania as part of his Pfizer research work.  In addition, recent Pfizer fellow, Dr. Gibson Kibiki, is a clinician and researcher at the KCMC which is the foundational international research partner of the newly named Herbert/Yeargan Center for Global Health at Duke University. The October symposium rekindled connections between infectious disease faculty at UVa and Duke. As a result, new collaborative possibilities are under discussion.

Conclusion

The fellows and scholars activities in international health have been significantly strengthened because of Pfizer Foundation support. The developing collaboration with Tanzania is growing rapidly thanks to our ability to engage a new UVa faculty member by bringing a fellow from Tanzania to work with him and by helping send scholars to work in Tanzania. Similarly, the nascent Guyana collaboration with fellow Rebecca Kightlinger is extremely promising, and we owe both these new opportunities to funding provided by Pfizer.

 

The Pfizer International Health Initiative has accomplished a great deal and established a foundation for more promising and rewarding advances. We are sincerely appreciative of the Pfizer Foundation’s generous support.