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Home > Global Health Matters Sep/Oct 2021 > Focus: Fogarty awards $3.3M in COVID-19 supplements to support research, training Print

Focus: Fogarty awards $3.3M in COVID-19 supplements to support research, training

September/October 2021 Volume 20 Number 5

Groups of people and a herd of animals walk along an unpaved toward the sunset.
Photo courtesy of NIAID                                                                     
Researchers in the U.S. and Latin America are collaborating       
on strategies to reduce childhood obesity, a growing global        
health problem.                                                                                    

Low-resource nations have faced significant challenges in responding to the COVID-19 pandemic and numerous researchers have had their projects disrupted. To help address these issues, Fogarty has awarded nearly $3.3 million in 42 administrative supplements to existing awards for one year of support.

Priority was given to COVID-19-related projects that address unique scientific questions associated with the pandemic in the low-resource country where the research is conducted. Precedence was also shown for COVID-19-related research training conducted in LMICs. Fogarty also provided supplementary support to researchers who were unable to complete their projects due to pandemic lockdowns.

The supplements will support research and training in a broad range of COVID-related topics. Several projects will examine the mental health aspects of COVID-19, particularly among people living with HIV. Others will study interactions between SARS-CoV-2 and other infectious diseases such as HIV and TB. In addition, supplements will fund COVID-19-related investigations into vaccine hesitancy, intimate partner violence, stigma and other topics.

The NIH Office of AIDS Research and the NIH Common Fund provided significant support for the awards. Several project examples are described below. 

Investigating vaccine hesitancy in Kenya

The COVID-19 vaccine is safe for people living with HIV (PLHIV), yet vaccination rates within this group have been lower than expected in Kenya. University of Washington’s Dr. Carey Farquhar received a supplementary award to define both barriers and facilitators of COVID-19 vaccine uptake among PLHIV in Kenya. Her team’s proposal also aims to identify strategies to overcome vaccine hesitancy while building research capacity at Kenyatta National Hospital (KNH) in Nairobi.

Vaccine hesitancy among PLHIV is not well understood. During the first phase of the study, baseline surveys will be conducted among patients accessing care at the hospital’s comprehensive HIV care center and the outpatient units. This will be followed by in-depth interviews and a survey administered to health care workers. These will identify attitudes and knowledge about the COVID-19 vaccine. “Understanding the patient-health care worker interaction will be key in promoting use of the COVID-19 vaccine,” said team member Dr. Nancy Ngumbau of KNH. Research capacity at the national hospital will be strengthened with four trainees gaining experience in research methodology via hands-on experience, mentorships, workshops and courses.

During phase two, stakeholders will participate in a two-day workshop to identify strategies for optimizing COVID-19 vaccine uptake among PLHIV. Participants will include health ministry leadership, NGOs, health care workers and networks of PLHIV. The study will use an integrated, implementation science approach to “ensure that interventions, strategies and policies will be developed to increase uptake of vaccination,” said Ngumbau. “Therefore, the results of this study can be rapidly adopted and used to influence optimal COVID-19 vaccine delivery for PLHIV in Kenya.”  

Studying intimate partner violence in India

Sodas and other beverages on display in Peruvian street market

Photo courtesy of  St. John's Medical College                               
 Scientists in India are using supplemental funds                         
to analyze partner violence during the pandemic                          

Across the globe, an unintended consequence of COVID-19-related lockdowns has been an uptick in domestic violence. In India, roughly a third of married women experience intimate partner violence even during normal times, according to University of Iowa professor Dr. William Story.

When the pandemic began, Story’s colleagues, Dr. Nancy Angeline Gnanaselvam and Dr. Avita Johnson, were in the Bangalore suburbs collecting data on attitudes surrounding violence against women for a Fogarty-funded study. “We were able to interview women both before the COVID-19 lockdown and then after,” said Story. His supplemental grant from Fogarty will enable him to analyze this data and also re-interview some women given that initial trends were “curious.” “Intimate partner violence in some populations decreased after the lockdown, when we expected to see an increase,” he said.

Since many people moved during the pandemic, he noted, someone in an abusive relationship may have relocated away from their partner. With liquor stores and bars closed, alcohol consumption might have decreased. “It’s a complex pattern that we want to look into more deeply,” Story said.

Peri-urban neighborhoods—created by the settling of previously rural areas near cities—are appearing throughout Southeast Asia and in other regions. For this reason, Story believes his work will be applicable to settings beyond India. Story hopes his data will also inform his work developing an intervention for teens that addresses patterns of behavior around concepts of masculinity. The new funding will also support data analysis instruction for the research team at St. John’s Medical College in India.

“Supplements are great for being able to look at a question that maybe we weren’t expecting to come up during a study,” Story said. “COVID has put us in a position of asking extra questions and looking at things a little bit differently and I want to continue to practice that moving forward.” 

Examining antibody response to SARS-CoV-2 in Sierra Leone

Sierra Leone has experienced much lower COVID-19 caseloads and much less disease severity than countries in other parts of Africa. Preliminary testing done on blood samples collected prior to the pandemic showed Sierra Leoneans had a higher antibody response to SARS-CoV-2, SARS-CoV, MERS and and other human coronavirus strains than their U.S. counterparts. 

“One theory is that there may be other circulating coronaviruses in that part of the world that don’t necessarily cause disease—or severe disease—yet may be providing some level of protection,” said Vanderbilt University’s Dr. Troy Moon.

Vanderbilt and its partners at Tulane have been using a Fogarty grant to help build research capacity in Sierra Leone in the wake of the 2014-16 Ebola outbreak. With supplemental funding, Moon and his colleagues will expand on this preliminary data to determine the percentage of participants who are seropositive to different human coronaviruses, including SARS-CoV-2, both before and during the pandemic, but prior to vaccination. In addition the team will determine the proportion of positive-testing patients whose serum has neutralizing antibodies against SARS-CoV-2. Finally, the team will determine if this pre-existing immunity has any impact on the immune response in their cohort of participants following COVID-19 vaccination.

The onsite work will be led by Sierra Leonean investigator Dr. Robert Samuels, who recently trained at Vanderbilt as a scholar with support from the original Fogarty grant. Samuels will apply his newly acquired knowledge of research methods and management to lead and oversee the day-to-day implementation of the study, while gaining hands-on experience.

Moon believes this research could provide essential clues to further understand how coronaviruses operate. “I think it opens up many questions as we try to better understand our immune response and coexistence with different respiratory pathogens and how that affects us at different time points when we see different illnesses,” he noted. “This is now the third pathologic coronavirus epidemic we've seen and one that probably will be with us for a long time. This is not going to be the last time we hear from coronaviruses.”

Training researchers at Rakai

Sodas and other beverages on display in Peruvian street market

Photo by McKinda Jackie/Rakai Health Sciences Program         
Fogarty grant supplements will suport an array of COVID-19      
related activities such as mentored research training                  
in Rakai, Uganda.                                                                                

The COVID-19 pandemic has interrupted HIV treatment and prevention services throughout Africa. Given the limited number of health workers and researchers on the continent, a clear need exists for immediate capacity building and research training specific to the HIV/ COVID-19 syndemic. To help meet that need, Johns Hopkins University’s Dr. Larry Chang and Rakai Health Sciences Program’s Drs. Fred Nalugoda and Godfrey Kigozi will establish an HIV/COVID-19 Training and Research Initiative at the Rakai Health Sciences Program in Uganda through a supplement to the existing grant.

The Rakai Health Sciences Program is an extramural training site for Makerere University that provides field training for Ugandan and U.S. students. The program can implement and support HIV/COVID-19 research and capacity building through the Rakai Community Cohort Study, which has been collecting sociodemographic, behavioral, health and other data since 1994.

The supplement, like its parent grant, aims to support locally relevant research. Planned activities include didactics and discussions, mentored research, online writing accountability groups, data science training and in-country mini-sabbaticals. 

Advancing implementation science in Malaysia 

Malaysia—spared in the earliest days of the pandemichad the largest COVID-19 case load per capita by the spring of 2021. Concurrently, this Asia-Pacific nation is battling a rapidly expanding HIV epidemic. COVID-19 has been an “implementation disruptor,” stalling research and the prevention and treatment of HIV in Malaysia, noted Yale University’s Dr. Frederick Altice in his supplement proposal.

With the additional support, Altice and his colleague Dr. Adeeba Kamarulzaman will establish COVID-19- related trainings and activities through an existing implementation science training program. These will include a series of lectures on COVID-19 and an expansion of the summer bootcamp to address issues directly related to COVID-19. In addition, research funding will be provided so faculty members can conduct pilot projects focused on both COVID-19 and HIV.

The nation of 32.8 million people has more than 100,000 cumulative cases of HIV. Recent rapid growth is attributed to an inadequate scale-up of evidence-based interventions, including access to HIV testing, pre-exposure prophylaxis, antiretroviral therapy and syringe exchange programs. 

Building biostatistical capacity in South Africa

COVID-19 disease, when combined with existing high rates of HIV/AIDS and tuberculosis, threatens fragile healthcare systems and infrastructures in sub-Saharan Africa. Policymakers require quality evidence to prevent and treat COVID-19. Instead, they face an “infodemic”innumerable studies conducted across the globe, many of poor quality, plenty with contradictory findings, noted Dr. Taryn Young of Stellenbosch University.

With her supplementary grant, Young will develop training to support evidence synthesis and network meta-analysis to inform COVID-19 and HIV policy and practice decisions. Young’s team plans to increase capacity by developing an online course that instructs participants to find, appraise, interpret and consider the use of network meta-analysis and systematic reviews. The South African team will also develop a global network meta-analysis master class for researchers, decisionmakers and students in HIV/AIDS. This online workshop will build regional capacity and cultivate analysis and systematic review skills. “We are busy registering the short courses and developing content,” said Young, noting that the courses will be offered early in 2022.

Having seen the pandemic’s disruption of care delivery systems, she believes that the pandemic will likely reverse gains achieved over decades by HIV programs. Young’s supplementary project aligns with her parent grant, which aims to establish an Africa Center for Biostatistical Excellence. “There is an urgent need for data driven interventions to address these threats to African populations.” 

Determining the mental health of Ugandan youth

Sodas and other beverages on display in Peruvian street market

Uganda responded to the COVID-19 pandemic with stern measures, including a lockdown, shelter-in-place requirements and school closures. This strict approach exposed youth living with HIV (YLHIV) and their families to a variety of stressors, including social isolation, anxiety, loneliness, difficulty accessing medications and disruptions in economic activities, explained Dr. Fred Ssewamala of Washington University in St. Louis. With supplementary support from Fogarty, he plans to examine the pandemic’s impact on the mental health of YLHIV in Uganda.

Ssewamala and his team will interview 500 YLHIV across 39 health facilities in the greater Masaka region of Southwestern Uganda. Prevalence of HIV and AIDS in this region is 8% compared to about 6% nationally. His primary aim is to gain a clearer understanding of “the intersectionality of the consequences of two viral infections at a physiological level: HIV and COVID-19,” he said. “We need to understand the psychological impact of the pandemic in real time in order to design appropriate measures to address any challenges.”

Ssewamala’s team anticipates seeing increased depression, anxiety and post-traumatic stress disorder in study participants. “We know that prior large-scale disasterssuch as Ebola and SARS—had a negative impact on the psychological wellbeing of patients and healthcare providers,” he noted. “However, we have never witnessed such drastic control measures before.”

During the project, Ssewamala and his colleagues will be training and mentoring the cadre of 18 Ugandan scientists chosen under his original research training grant. Participants will learn “rigorous and culturally-congruent research methods,” he said. He hopes to exchange data and lessons learned with other Fogarty awardees and, eventually, plans to disseminate his findings among the broader scientific community. “The lessons are potentially transferable to other low-resource settings in sub-Saharan Africa.”

Understanding stigma in Nigeria 

Nigeria has a high burden of HIV-related brain disorders, including mental health illnesses and neurological impairment. Dr. Babefemi O. Taiwo of Northwestern University in Chicago estimates that HIV-associated neurocognitive disorders alone affect many Nigerians living with HIV, but exact numbers are not known. Taiwo, supported by an award attached to his HIV Research training grant, will look at the intersection of COVID-19 and HIV amongst people living with HIV (PLHIV) in Nigeria. “We have a particular interest in how mental health issues have been impacted, which will include how stigma might have played into that.” 

PLHIV historically bear a disproportionate share of mental health challenges caused by both the diagnosis itself and the environment, he explained. Pockets of stigma still exist in Nigeria—like in many parts of the worldand COVID-19 has added to this psychological burden. Meanwhile, the lockdown complicated pre-existing mental health issues and restricted access to treatment. “Testing for COVID-19 is not widespread and there is a lot of misinformation, fear and stigma,” Taiwo noted. “So what you have now is a confluence of mental health challenges from COVID-19 and HIV that, for PLHIV, can be quite significant.” This “entanglement” often leads to poor adherence to treatment, the cornerstone of success.

Ongoing research includes longitudinal data on depressive symptoms and HIV care adherence both before and after the onset of the pandemic, explained Dr. Bibilola Oladeji, Taiwo’s colleague who will lead the research team in Ibadan. “We want to leverage this data to explore the effects of the COVID-19 pandemic-related lockdowns and movement restrictions on depressive symptoms.” The team expects to gain a better understanding of how COVID-19 is impacting the mental health of PLHIV, which age groups are most affected and how to use that information to develop interventions.

Progress is underway. The team has selected trainees and brought together key stakeholders. Currently, they are developing lectures, courses and other educational experiences. Oladeji said, “Trainees will explore available data and develop qualitative data as part of their hands-on training and to fulfill the program’s capacity building activities.” Taiwo concluded, “This supplement will help nurture another group of investigators with an interest in the mental health and neurologic complications of HIV infection.” 

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