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Research at NU

The Center for Global Health

  • Nigeria, Mali: Funded by the Fogarty International Center (FIC) at the National Institutes of Health (NIH) in June 2008, NU AITRP implements interdisciplinary training to improve the overall capacity of Nigerian and Malian collaborators to conduct HIV/AIDS clinical and laboratory research with emphasis on the national priority areas. By providing comprehensive training in epidemiological concepts and methods related to AIDS research, NU AITRP aims to increase the foreign scientists’ capacity to conduct epidemiological studies, clinical trials and prevention research. Northwestern has developed partnerships with three institutions: the University College Hospital (UCH) at University of Ibadan in Nigeria, Jos University Teaching Hospital (JUTH) at University of Jos in Nigeria, and the University of Bamako in Mali - Center for HIV and TB Training and Research (SEREFO).

  • Nigeria, Tanzania: The Center for Global Health participates on the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in Nigeria and Tanzania, which is funded by the U.S. Department of Health and Human Services (DHHS) through a grant awarded to the Harvard School for Public Health. The Center’s role in the PEPFAR project involves: Education and training, supply chain management, and research.

  • United States: EraMune 02 HIV Eradication - The EraMune 02 is a clinical trial exploring a new approach to try to completely remove HIV from an infected individual by attacking latent (hidden) virus in viral reservoirs through intensification of antiretroviral (anti-HIV) treatment with the addition of an investigational vaccine that can activate cells infected with HIV to create an immune, or disease fighting, response to the virus’ DNA. EraMune 02 is a nation-wide trial that has three sites/teams: Chicago (Northwestern University), San Francisco (University of California), and New York (Cornell University). Overall, 28 HIV-positive patients will have their antiretroviral treatment intensified and will be randomly assigned to either a control or an experimental group. The experimental group will receive an additional vaccine treatment, in the hopes that this new combination will completely eradicate HIV from the infected individual’s body.

  • Kampala, Uganda: Multi-Pathogen Point-of-Care Diagnostics in Uganda - Multi-pathogen point-of-care diagnostic tests for infectious diseases have the potential to confer great benefits in the developing world, improving the efficiency of the diagnostic process, reducing improper treatment and costs, and ultimately improving patient outcomes. Two such diseases with high burden are tuberculosis and community-acquired pneumonia. Cost-effectiveness analysis of these prospective tests are yet to be performed. Herein, I propose to contribute to the development of a cost-effective analysis of said tests for TB, MDR-TB, and CAP through a university-based initiative in Uganda, in hopes of taking new steps at the interface of Global Health and biotechnology. Equally important, this project empowers future Ugandan leaders with the skills they need to take these steps themselves. Investigator: Mitra Afshari 

  • Palacios and Santa Cruz, Bolivia: Barriers to Accessing Sexual Assault Services for Rural Bolivian Women - Sexual violence is a significant problem in Latin America, with high prevalence reported in many areas. Victims of sexual violence are at risk for a host of mental and physical health problems, however utilization of services to help prevent or treat the problems associated with sexual violence is low. Previous research has identified a variety of barriers to accessing services for sexual assault survivors, including availability, affordability, accessibility (e.g. transportation), and acceptability (perception of harm or benefit of a given service). In general, the stigma and self-blame associated with rape have been found to be extremely important barriers to getting help following sexual assault. This study will examine barriers to utilizing services related to sexual assault in a population of adult women in rural Bolivia served by the Centro Medico Humberto Parra. It will begin by identifying availability and cost of services for survivors of sexual assault. It will then use structured interviews with adult women to learn more about their opinions of sexual violence and their knowledge and perceptions of services for victims of sexual assault. Investigator: Lindsay Fox

  • Nairobi, Kenya: Assessing the Plastic and Reconstructive Surgery Needs Along the Continuum of Care in An East African Setting - It has been estimated that surgery can address 7% of Disability Adjusted Life Years in Africa1. The WHO has launched the “Safe Surgery Saves Lives” program, recognising that surgery is a public health issue. Disfigurements as a result of injury (e.g. burns, severed limbs), disease (e.g. leprosy), or congenital deformities (e.g. cleft lip and palate) all lead to debilitating and long-lasting effects on the livelihood of individuals caused by negative health outcomes, stigma and considerable economic burden due to potential loss of income. The proposal herein descries a two phase project aimed to improve plastic and reconstructive surgical capacity in East Africa. My role during the proposed IHF-sponsored internship will be in the first phase, which is to conduct a needs assessment for reconstructive surgery in Kenya. The aim of the project is to determine the current practices in reconstructive surgery as they pertain to congenital and traumatic deformities such as limb reconstruction and burn-related injuries, and to determine the need to establish appropriate surgical programs along the continuum of care which are necessary for successful recovery. The needs assessment will combine focussed group interviews with health care professionals, ministries of health and surgical training teams in both urban and rural areas of Kenya; and standardized questionnaires to reach a wider number of health care professionals and to differentiate greater needs based on geographic locations. The second phase and long-term outcome of this project is the establishment of a new surgical training program and surgical centers of excellence in Kenya that will serve to train local surgeons, nurses and post-operation care staff to serve the greater area of East Africa. The project is being undertaken by the University of Toronto’s Division of Plastic and Reconstructive Surgery, in collaboration with the African and Medical Research Foundation and The Feinberg School of Medicine of Northwestern University. Investigator: David W. Grant

  • New Delhi, India: Motorized Two Wheeled Vehicle Riders in New Delhi: Patterns of Injury and Attitudes on Helmet Use - Data from sites worldwide demonstrate efficacy of helmet use in preventing mortality and morbidity from traumatic brain injury in two wheeled vehicle road traffic accidents. However, there nevertheless exists a long history of debate between those in favor of mandatory helmet use and those opposing such mandates as an infringement on the rights of the individual. India, a country of 1.2 billion with 70% of registered vehicles representing motorized two wheelers, is a prime example. In 1997, the Indian municipality and capital New Delhi attempted to mandate helmet use for all motorists on two wheeled vehicles, but public opposition based on religious and cultural beliefs forced an exemption in the law for all women and all Sikh riders. Objectives: First, due to locoregional differences, we must identify the attitudes toward helmet use among women of the distinct socioethnic and religious groups within New Delhi. Second, to assess adherence to current law and impact of attitudes on actual use, we must accurately identify rates of MTW rider helmet usage. Third, we must demonstrate if there is a lower rate of intracranial injury and pre-hospital death in helmeted versus non helmeted drivers and pillion riders, especially women and Sikhs. If the chart review demonstrates significant differences in mortality and morbidity, length of stay, etc, then these data can be used to advocate review of current legislation and ultimately mandate helmet use for all MTW drivers and pillion riders without exception. This data will also be used in conjunction with the survey data and actual helmet usage data to develop a city wide campaign to improve actual helmet usage rates. Investigator: Selma Siddiqui

  • Heidelberg, Germany: The Significance of Tumor Associated Antigen Specific Tregs in Colorectal Patients Peripheral Blood in Expanding Treg Response in those Patient’s Tumors - Colorectal cancer is the third leading cancer killer in the United States with a incidence of more than 140,000 in 2010. Patients with stage IV disease who are given the current standard of care, have a 5-year survival rate of only 6 percent. It is therefore necessary to continue to search for more effective therapies, and cancer vaccines are one promising area of development. With the discovery of Tumor associated antigens (TAAs) researchers have found a potential target for future vaccine development. Furthermore, it is known that there is some natural degree of anti-tumor immunity in colorectal carcinomas. However, this response is downregulated by regulatory T cells (Treg), and increased Treg response is associated with decreased survival. To evaluate this downregulation, the frequency and activation status of Treg and effector Tcells on paraffin sections from approximately 30 colorectal carcinoma patients who have had surgical removal of their tumor will be quantified by utilizing six staining combinations on serial sections: CD4+CD69, CD4+CD107a, CD8+CD69, CD8+CD107a, Foxp3+CD4, Foxp3+CD8. Investigator: Ashima Singai

  • Jos, Nigeria: Assessing Liver Disease in HIV/HBV Co-infected patients using Fibroscan®, in Jos, Nigera - Although HIV/HBV co-infected individuals are at higher risk for liver disease progression than those with chronic Hepatitis B (HBV) alone (Puoti et al. 2006), little is known about the prevalence of liver disease in resource limited settings (RLS), and better diagnostic and prognostic tools are needed. The proposed study aims to 1) determine the prevalence of liver fibrosis and cirrhosis using the Fibroscan®, among HIV-infected patients, both with and without HBV co-infection who are enrolled at a AIDS Prevention Initiative Nigeria’s (APIN) U.S. President’s Emergency Plan For AIDS Relief (PEPFAR) funded HIV Care and Treatment Center in Jos, Nigeria and 2) among HIV/HBV co-infected patients, assess the correlation between severity of liver disease and HBV viral, serologic and genotypic markers. This study will have multiple potential benefits for HIV/HBV infected patients in RLS, providing more accurate data on the burden of liver disease among these individuals, as well as the prognostic and diagnostic utility of serum HBV markers in liver disease. The findings of the study will inform the standard of care for monitoring and treating patients with HIV and HBV in RLS such as Nigeria, and improve our ability to effectively prevent and manage liver related morbidity and mortality. Investigator: Erika Wallender

Global Health Initiative (GHI) - Kellogg School of Management

  • Botswana: GHI sent the Kellogg field team to Botswana in summer 2008 to conduct field research focusing on infant diagnosis.  The purpose of the market research wais to study the size and growth of the infant diagnosis market in Botswana, understand the interest, and pinpoint the unmet needs for HIV/ADIS testing, especially for infant diagnosis.  GHI teams interviewed extensively with the key stakeholders and collected valuable market information.  Different diagnosis technology concepts were also tested to identify the most desired product attributes for infant diagnosis in Botswana.

  • Cambodia:  GHI aims to redesign existing technologies so that infants can be diagnosed around 6 weeks of age using a test that is accurate, low cost, and easy to administer.  To understand the interest and needs for HIV diagnosis and infant testing in Cambodia, a GHI team conducted extensive Field Research through site visits and interviews with key opinion leaders (government, healthcare providers, international agencies, NGOs, and community based organizations).  The role of each stakeholder for HIV, especially for infant testing, was identified, and the best approaches to engage the key stakeholders were evaluated. The GHI team also conducted product concept tests, identified the important product attributes, and evaluated the acceptance and preference of different technologies in Cambodia.  Stakeholders in Cambodia received GHI’s proposals for a point of care infant diagnostic for HIV with high enthusiasm. With 77% total cost savings the device is both cost effective and efficient, delivering faster results to mothers. 

  • Mozambique: The GHI Kellogg team conducted Point of Care Infant Diagnostic Analysis in Mozambique in 2008. The field team visited healthcare facilities involved in infant HIV/AIDS diagnostics in the country, met with key stakeholders and thought leaders in HIV/AIDS programs, investigated the DBS process flow, and analyzed the constraints of the current DBS system. The GHI team also gathered information on the approval process of the HIV/AIDS diagnostic devices, the supply chain and the distribution of such devices in Mozambique.  Similar to the GHI Infant Diagnosis field studies conducted in other countries, the market size of infant HIV/AIDS testing was evaluated, and the new diagnosis product concept was tested in Mozambique. 

  • Namibia: In 2008, GHI teams conducted a field research study on HIV/AIDS treatment and infant diagnosis in Namibia.  With focus on an infant testing devices market study, the GHI Kellogg team met with health care facilities and providers, and interviewed with key opinion leaders in Namibia.   The GHI team investigated the current infant diagnosis status, the infant testing techniques available, and constraints of the existing program in Namibia.  The team also analyzed the market size and growth for infant diagnosis in Namibia, studied the barriers of entry, and identified the potential collaborators.  The roles of the major stakeholders for HIV/AID diagnosis were studied and their interest in the GHI point of care infant diagnosis was gauged. 

  • South Africa: In 2008, a group of Kellogg graduates met with key thought leaders in HIV/AIDS programs, in South Africa and Mozambique, and also visited a number of healthcare facilities involved in early infant diagnosis of HIV.  The team conducted Point of Care Cost-Benefit Analysis to better understand the key costs and benefits issues of the current infant HIV/AIDS diagnosis system. The national market size for infant tests was estimated and unmet market needs were determined.  Product concepts were tested, and key attributes such as accuracy, mobility and efficiency were evaluated by the local health care providers.

  • Tanzania: In March 2008, GHI sent 40 Kellogg School of Management students and faculty members into Tanzania to conduct market research and product concept testing on point of care HIV diagnostic tests. The research that took place was primarily focused on learning about the market for point of care HIV diagnostics in Tanzania.  Students met with health care providers, government officials, international NGO representatives, distributors and others to learn about both the current state and diagnostic needs in Tanzania.  Findings from these research efforts include a determination that infant diagnostic devices were judged to be the highest priority out of all GHI's HIV diagnostic technologies under development.  The research team also gathered a great deal of data about the resource constraints in place in Tanzanian health care facilities.  These results were transmitted to the engineers back at Northwestern to incorporate those factors into their technology designs.

  • Uganda: The GHI Uganda team conducted primary and secondary research in March 2009 that had an immediate and lasting impact on the product specifications, manufacturing, and market entry strategy for the infant HIV diagnostic test designed specifically for use in resource-limited settings. Students were organized into six project teams focused on the key stakeholder groups.  The teams took a deeper look at the operational, political, legal and regulatory context in which HIV products must ultimately compete and advance understanding about the needs, interests and concerns of key stakeholders. Specifically, teams worked on: Refining product requirements and specifications for pre-selected HIV/AIDS diagnostics tools for use at the point of care; Analyzing the business, institutional, political and financial framework for implementing new HIV/AIDS rapid diagnostics tools in Uganda; Determining market size to inform potential test manufacturers.

Center for Innovation in Global Health Technologies - McCormick Northwestern Engineering

  • Zambia: Pelvic exam simulator for educating midwives in rural Africa - The training of health professionals in US medical schools relies increasingly on sophisticated simulators.  Low-cost versions of these devices are needed in poor rural settings where midwives deliver the bulk of pre-natal and post-natal care. Northwestern is working with the African Midwife Research Network in Lusaka Zambia to design and build an appropriate simulator for use across southern Africa.

  • Chile: Arsenic removal from drinking water in the Atacama Desert, Chile  - The little water available in northern Chile is contaminated by natural inputs of arsenic from hydrothermal discharges generated by the Puna-Altiplano volcanic complex.  As a result, public health in this area has historically been impacted by the chronic arsenic exposure in drinking water. Rural mountain villages typically have only limited and often poorly functioning arsenic removal systems.  A collaborative effort between NU and Pontificia maintainable by small communities and tailored to local water chemistry.

  • South Africa: Tuberculosis Tracking System - The project involves monitoring diagnostic and treatment regiments in the Site B clinic, which serves the people of the largest of Cape Town’s townships. Because patient tracking is largely unavailable in these clinics, patients diagnosed with TB are too often lost to follow-up as a result of inefficient filing and communications systems. The problem is exacerbated by patient behavior and systematic disincentives that discourage patients from presenting for follow-up. This is an ambitious project, which employs the ideas of both industrial engineering and organizational behavior.

  • South Africa: p24 Antigen Rapid Test for Pediatric HIV Diagnosis - Currently, the majority of HIV-infected infants are found in resource-poor settings in the developing world, where the high cost and time required to process conventional diagnostics often prevents timely administration of crucial antiretroviral therapies. Responding to the need for affordable tests and fast diagnoses, CIGHT laboratories developed a low-cost, dipstick p24 antigen that provides a visual readout format and yields a result in less than forty minutes. The speed and simplicity of the p24 antigen test (requiring minimal plasma volume) allow for a same-visit diagnosis and thus timely treatment. Clinical trials of the p24 antigen test began in July 2011 at the University of Cape Town, South Africa. (Read the article published in the Journal of AIDS).  
  • South Africa: Breast Milk Pasteurization for HIV+ Mothers - Preventing transmission of the HIV virus from a nursing mother to her infant presents a significant challenge in the developing world. Working under the guidance of CIGHT, Northwestern University senior biomedical engineering design teams have developed a low-cost, user-friendly breast-milk pasteurization device. The system processes the milk in a common "allycat style" glass peanut-butter jar that has been fitted with a temperature sensor, an agitator, and an indicator that tells the mother when the milk has reached a temperature that will deactivate the HIV virus. The sensor--a bimetal disk--responds when the breastmilk in the jar reaches the required temperature, causing the indicator wire to flip up, thus giving the mother auditory and visual assurance that the milk is now safe for her child. As of May 2011, the breast milk pasteurization device is undergoing additional testing at the University of Cape Town, where CIGHT researchers and Northwestern University senior biomedical engineering design teams will refine the agitator and indicator components and obtain user feedback from mothers at the Mowbray Maternity Hospital. (See the video presentation on CIGHT's current work in Cape Town.) 
  • South Africa: Typically, a premature infant in the industrialized world will be placed in an incubator, and the incubator's temperature carefully regulated to assure the health of the infant. In developing nations, by contrast, a mother will typically swaddle the infant to her chest, her own body providing exactly the level of thermoregulation that the preterm infant needs - no incubator necessary. This method is called Kangaroo Mother Care (KMC), and it is now the gold standard of therapy for preterm infants in the developing world. However, preterm infants also suffer from respiratory distress syndrome with the risk of lung collapse. Consequently they must be fitted with continuous positive airway pressure (CPAP) devices that maintain pressure on the lungs so that the infant can breath. Yet, if fitted too tightly to the infant's nose and face, the CPAP device can cause pressure sores and lead to a septum collapse in the delicate newborn. At this stage, the infant faces painful and expensive reconstructive surgery. To combat this, CIGHT and a Northwestern University senior biomedical engineering team worked to design a visual force indicator that would let mothers and caretakers know when the pressure from the CPAP device exceeded safe limits so that they could make adjustments. The CIGHT prototype uses green markings on the side of the forge indicator to mark safe pressures, while a red line shows when the device should be loosened. As of May 2011, CIGHT and the NU BME team are obtaining user feedback from healthcare professionals at the University of Cape Town, South Africa. (See the video presentation of CIGHT's current work in Cape Town.)
  • South Africa: Much of the developing world lacks skilled healthcare professionals capable of providing patients with accurate diagnoses. To address this need, a team of Northwestern senior design students working with CIGHT developed the DxDb Client, an electronic diagnostic aid created to empower local healthcare workers to make more accurate diagnoses. Designed for the Android platform, the DxDb Client digitizes World Health Organization (WHO) protocols for Integrated Management of Childhood Illnesses, or IMCI. For their first prototype, the NU team focused on enabling healthcare workers to diagnose the cause of fever in infants. The application begins by walking the healthcare worker through the IMCI protocol for fever, telling the user what questions to ask and what observation to make. Additionally, DxDb provides user with auditory and visual resources to help them conduct more effective patient exams. Finally, once all data have been collected, DxDb generates a possible diagnosis and suggests a treatment plan. DxDb also saves aggregates medical record data to a database for research purposes and the eventual development of advanced diagnostic algorithms. As of May 2011, CIGHT researchers and NU major biomedical engineering design teams, working at the University of Cape Town, will measure the effect of the application on health care worker performance and diagnosis accuracy as well as obtain user feedback from local healthcare workers and specialists. (See the video presentation of CIGHT's current work in Cape Town.)
  • Malawi: Post-partum hemorrhage is the leading cause of maternal mortality. Active Management of the Third Stage of Labor (AMTSL) reduces the risk of postpartum hemorrhage by sixty percent. Unfortunately, healthcare workers in the developing world rarely have access to medical training devices that can meet their unique needs and are affordable. To address this need, a Northwestern University senior biomedical engineering team under guidance from CIGHT developed the SIMenta, a placenta simulator for improving training of midwives and birth attendants in the developing world. The current SIMenta prototype consists of two custom-molded simulated placentas, one normal and healthy and the other with significant medical abnormalities. In addition, the prototypes incorporate a feedback mechanism into the umbilical cord indicating the proper tension that a healthcare worker should use when pulling on the umbilical cord. Weighing less than three pounds and less that a cubic foot in volume, the SIMenta is highly portable, and components are washable, dirt, water, and heat-resistant and inexpensive to replace. As of May 2011, the NU team is working with an interdisciplinary team from the Kellogg School of Management Social Enterprise Program to conduct market research for their design in Malawi. (See the video presentation for more details.)

The Research Alliance to Combat HIV/AIDS (REACH) - Program of African Studies

  • Nigeria: REACH was conceived out of the realization that many ongoing prevention initiatives in Nigeria have been insufficiently informed by scientific studies and regular and systematic evaluations. REACH began its work by conducting background research on HIV prevention issues and identifying relevant stakeholders in Nigeria. REACH has also begun designing a framework and methodology for the conduct of the community-level case studies by multi-disciplinary research teams. Two main approaches have been identified in conducting these community-level case studies: 1) a longitudinal study, beginning in two culturally diverse communities in Nigeria, and 2) a site survey (cross-sectional) of clinical prevention services across the country, initially beginning with 3 sites.

Laboratory for Human Biology Research

  • Western Samoa: Culture change, stress, and immune function in Samoan youth - Samoans are currently experiencing an unprecedented period of cultural diversification:  non-traditional legal, political, and economic institutions continue to encroach, and western consumer goods and lifestyles are increasingly available and desired.  A recent epidemic of adolescent suicide suggests that these transitions may be problematic, particularly for the youth of Samoa. The objectives of this research are threefold:  1) To introduce a cross-cultural and developmental perspective to the large body of western-based research in stress and immune function; 2) To evaluate new methodological tools for assessing immune function in field settings; and 3) To develop models of culture change and stress specifically relevant to the experiences of youth.  A blood spot measure of EBV antibody level was developed as an immunological measure of chronic stress, and assayed in over 800 samples from 5-20 year-olds living in a range of urban and rural Samoan villages.  C-reactive protein levels were also assayed to control for pathogen burden. Adolescents living in more westernized areas of Samoa, as well as adolescents from households with high levels of incongruity in aspects of social status, have elevated EBV antibodies, indicating lower immunocompetence and a higher burden of psycho- social stress.  This work has been significant in introducing new methodological tools for assessing stress, and in evaluating new models of culture change specifically relevant to the experiences of youth.

  • Kenya: Ecology of iron deficiency and immune function in northern Kenya - This research explores iron- deficiency as a potentially adaptive response to infectious disease among Rendille children in the Marsabit District of northern Kenya.  This group of formerly nomadic pastoralists is becoming increasingly settled around towns and mission stations, and children endure relatively high rates of anemia, undernutrition, and infectious disease. Like fever, the iron-withholding response has been identified as a potentially adaptive response to infection by limiting the bioavailability of iron for invading microbes.  However, iron deficiency is recognized as the most common micronutrient deficiency in the world, and supplementation is often recommended, particularly for children and women of childbearing age. By developing a blood spot method for measuring serum transferrin receptor, and using this measure in conjunction with other markers of infection (CRP), iron status/anemia (zinc protoporphyrin:heme ratio, hemoglobin), and immune function (EBV antibody level), we hope to define optimal iron status, and to explore the relationships among iron, anemia, immune function, and infectious disease risk.  

  • Philippines: Long term effects of prenatal and postnatal environments on adolescent immunocompetence in the Philippines - Recent research has considered the fetal and infant origins of several adult cardiovascular and metabolic diseases, but the long-term consequences of early environments for human immune function remain to be investigated. With collaborators at the Carolina Population Center and the Office of Population Studies, we are investigating the association between prenatal undernutrition and adolescent immuno- competence in the Cebu Longitudinal Health and Nutrition Study. Adolescents who were born small-