MUSC professor evaluates impact of HIV testing programs in East and West Africa

To find solutions to twenty-first-century public health problems, collaboration is more important than ever. The Agency for Healthcare Research and Quality (AHRQ) lists “teamwork” as its first example of an approach to improving health care coordination. This shift from volume-based to value-based care is firmly taking hold, albeit with the rightful nudge from government and consumer advocates. The necessary evaluation components of public health and medical programs often require global, cross-discipline expertise to promote best practices that until recently have been sparse. Multidisciplinary research teams comprising experts from the world over are now solving some of the most consequential medical and healthcare issues of the day—the most notable of these is HIV/AIDS.

One of those experts, Jeffrey Korte, Ph.D., MSPH, Assistant Professor of Epidemiology in the Department of Public Health Sciences at the Medical University of South Carolina (MUSC), was enlisted by International Initiative for Impact Evaluation (3ie) to evaluate two promising HIV projects in collaboration with Jhpiego. The first is a program for implementing a strategy to increase HIV self-testing among male partners of pregnant women in prenatal care in Kenya. The second project seeks to increase retention on antiretroviral (ARV) therapy by using a quasi-experimental approach to examine the integration of HIV care with clinical services in Côte d’Ivoire (Ivory Coast), Africa. “It was remarkable that 3ie would put on the workshop in Nairobi, Kenya that opened the door for me to build a team and design the Kenya project,” said Korte. “The extensive planning and interaction with colleagues on the ground were necessary to kick-start these projects.”

Jhpiego and 3ie both work to develop evidence-based, innovative approaches to global public health interventions; the latter is focused on encouraging all groups working in developing countries to design their projects in such a way to allow a rigorous evaluation of the impact – a critical element that is too often overlooked. Korte explained that through working with partners both in the United States and abroad he was able to develop relationships that led to his involvement in projects in East and West Africa. “The exchange of ideas and expertise is bidirectional for scientists in Africa and here in the states,” said Korte. “I learned a lot about clinical HIV interventions in Kenya, for instance. Although the context may be different, I’d like to bring those ideas back and start projects here.”

Sharing ideas across borders has resulted in scientific progress made to date, though some in the medical research community may be dissatisfied with static and increasing—in some countries—HIV incidence rates. Low testing rates, the single most important barometer for controlling the disease, have also weighed down progress. A recent report from the Centers for Disease Control and Prevention (CDC) estimates that about 1.2 million people in the United States over the age of 13 are living with HIV. Fourteen percent of those living with the disease do not know they are infected, contributing to unchanging incidence rates from year to year in the United States. Globally, 35 million people are currently living with HIV where new infections have declined by 38 percent since 2001. Women, minorities—specifically African Americans in the United States—and men who have sex with men (MSM) are at greater risk of contracting HIV and disproportionately lack access to treatment and prevention services. “HIV testing rates for women in prenatal care are roughly 97 percent in Kenya, whereas men are getting tested at a rate of 5-10 percent,” explained Korte. “We want people everywhere to know if they are positive so we can get them on treatment.”

Researchers are cognizant that social stigma creates a barrier to testing and subsequent treatment. The two projects Korte is conducting give credence to that very fact: an HIV diagnosis creates isolated communities not to be associated with because of their condition. Korte explained that while HIV self-testing is likely to have some unintended consequences, the benefits may be legion. “Self-testing opens up the possibility that Kenyan males can get tested more often given that the current thinking is that women go to clinics for tests and treatments, not men,” Korte said.

Korte’s second project in Côte d’Ivoire builds on a CDC-funded regional program now beginning, that provides technical assistance to the government in developing a system of HIV testing and treatment that is integrated into other types of screenings: blood pressure screenings, hemoglobin A1c, etc.—another strategy developed to minimize social stigma. Korte’s study will focus on differences in ARV retention attributable to the HIV care integration being implemented in certain regions of Côte d’Ivoire. “The rationale is having HIV care integrated with other types of services and screenings reduces stigmatization,” said Korte. “Our belief is that when these services are all offered together, and if there is needed treatment, adherence to that treatment will firmly take hold in both rural and urban clinics.”

It is also Korte and his colleagues’ belief that collaborating with researchers and non-researchers from different backgrounds produces meaningful, evidence-driven solutions that are “practically possible and has an impact on ourselves, MUSC, and the world.” When asked about the growing need for multidisciplinary global research at MUSC, Korte remarked, “It enlivens our careers to have different experiences with different kinds of people from a variety of cultures, and it is inspiring for students to hear about these kinds of projects so that the spirit of team-driven research continues in institutional settings.”