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Home > Global Health Matters Jan/Feb 2023 > Haitian TB researcher shifts focus to cholera outbreak Print

Haitian TB researcher shifts focus to cholera outbreak

January/ February 2023 | Volume 22 Number 1

Yvetot Joseph  wears a white lab coat in his office at GHESKIO in Port-au-Prince, Haiti

"It has been extremely challenging for us," is how Dr. Yvetot Joseph described the situation in Haiti in December 2022.

Haiti is currently suffering a resurgence of cholera, an acute diarrheal illness often spread through contaminated water. The ongoing humanitarian crisis, political conflict, lack of fuel, and suffering economy in Haiti have exacerbated the current outbreak. The Haitian Ministry of Public Health has reported over 13,000 cases and over 280 deaths as of mid-December.

Dr. Joseph joined the GHESKIO Clinical Trials Unit research team in 2015 as a research physician focusing on tuberculosis (TB) treatment for people living with HIV (PLWH). GHESKIO operates medical treatment and research centers in Port-au-Prince and other clinics around Haiti, and boasts the largest research center for HIV/AIDS and TB in the Caribbean. He completed his medical degree Université Notre Dame d'Haïti (UNDH) and post-graduate training in infectious disease and HIV/AIDS through a UNDH partnership with the University of Maryland, Baltimore. As a research physician and coordinator at GHESKIO, Joseph has had to adapt to ensure trials are still completed despite the unforeseen challenges in Haiti over the last two years.

In 2018 Joseph was accepted as a Fogarty Global Health Fellow in the Consortium of Vanderbilt, Emory, Cornell, and Duke (VECD), studying the association between successful TB treatment and the long-term mortality of those living with HIV under his mentors, Drs. Jean Pape, Karine Severe, and Dan Fitzgerald at the GHESKIO Centers in Port-au-Prince. He says, "the mentorship and training I received while working on my Fogarty project taught me skills that have been extremely helpful in today's climate."

From an early age, Joseph knew he would study HIV/AIDS as he noticed the extreme stigma around the disease. During one of his first clinical rounds, a person living with HIV was abandoned at the hospital by his parents and the head nurse asked for help cleaning the patient's bed sores. Though Joseph did not hesitate to care for the patient, his colleagues felt apprehensive about taking on the task.  "I understood from that moment that I wanted to help improve these patients' quality of life. I just remember their gratitude towards me."

The GHESKIO Centers building in Port-au-Prince, Haiti. Photo credit: GHESKIOThe GHESKIO Centers offer free medical care, including tests, diagnoses, treatment services and medications, to the poorest of the poor in Haiti.

With little data available on the long‐term mortality after successful TB treatment in PLWH, approximately 816 patients were enrolled to participate in a 14-year longitudinal study (CIPRA HT-001) between 2005 and 2018. It was known that, with medication and prevention strategies, PLWH in Haiti were living longer, and while TB is preventable and curable, it has remained one of the leading causes of death among this population, accounting for about one‐third of all reported HIV‐related deaths. When analyzing the data from this cohort, they found that those successfully treated for TB had a better chance for a longer life span compared to those who were never diagnosed. While there is still much to learn about the underlying mechanisms associated with TB, the immediate recommendation based on this study is to implement aggressive measures for health promotion and disease prevention for people living with HIV.

While Joseph hopes to continue this research, efforts at GHESKIO have shifted to focus on the current situation. As Haiti welcomes the first batch of cholera vaccines in the country, Joseph says that in the meantime, their strategy has been focused on educating the public on the signs of Cholera and encouraging them to seek help.

"After a patient is treated and cured, we ask them to serve as an ambassador for their community, educating them on the signs and symptoms of cholera and encouraging them to seek medical treatment as soon as possible," added Joseph.

Joseph will soon graduate from Cornell with a Master of Science in Clinical Research and plans to pursue his Ph.D. in the very near future. He says, "I am grateful for the mentors I have met through my Fogarty project and the opportunities it has opened for me."

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