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UCSF Pediatrician Hilary Wolf Receives GloCal Fellowship to Study HIV+ Adolescents in Kenya

UCSF pediatric fellow Hilary Wolf has found a way to integrate her dual interests in adolescent reproductive health and global health. Last spring she successfully applied for a fellowship program launched by the UC Global Health Institute, allowing her to live in Kenya for most of the year, conducting research on why HIV-infected adolescents are lost to follow-up (LTFU) at such high rates.

"There is a dearth of published studies identifying the reasons for LTFU of HIV+ adolescents in sub-Saharan Africa (SSA), thus limiting our ability to design feasible, acceptable and effective interventions for this large population of HIV-infected individuals," says Wolf. "Given the enormous burden of disease among adolescents and the life-long nature of treatment, enrollment and retention in HIV care are essential."

Wolf's project has two goals: 1. To evaluate in-depth why HIV+ adolescents aged 15-21 stop accessing HIV care, and 2. To explore the role of the school environment in affecting LTFU among HIV+ adolescents. She and her collaborators will explore the role of stigma, disclosure, school policies, and other aspects of the school environment.

Wolf is conducting her research at the joint UCSF and Kenya Medical Research Institute (KEMRI) HIV research site in Kisumu, Kenya. In this community 57% of the HIV+ adolescent patients are documented as LTFU.

HIV is a leading cause of morbidity and mortality among adolescents in the developing world. Adolescents represent 40% of all new HIV infections worldwide and 60% of all new infections in SSA, says Wolf. If HIV+ adolescents don't receive consistent health care they are at risk for developing resistance to ARVs, treatment failure, the development of opportunistic infections, increased risk of sexual HIV transmission, and ultimately premature death.

Wolf is able to spend the year in Kenya doing this important research because of the UCGHI GloCal Health Fellowship program, which is providing $4 million in funding to approximately 11-12 UC fellows annually for the next five years. The GloCal Fellowship, which launched in 2012, supports a long-term (11-month), mentored research fellowship for existing and aspiring investigators who are interested in studying diseases and conditions in developing countries. Trainees are matched with top-tier global health faculty from one of the four participating UC campuses and an international site, fostering scientific and career development in global health research.

The fellowship is sponsored by the National Institutes of Health (NIH) Fogarty International Center (FIC), as well as a consortium at the UC Global Health Institute and 25 affiliated international sites across 14 countries (Bangladesh, Brazil, Chile, China, Ethiopia, India, Kenya, Mexico, Mozambique, Panama, Peru, Uganda, Ukraine, Zimbabwe); and institutes and centers at the National Institutes of Health (NIH).

There are no published studies that have interviewed HIV+ adolescents in SSA who have been LTFU or their teachers regarding determinants of LTFU or the role of the school experience in retention of care, says Wolf. However, research Wolf conducted in August 2011, when she came to Kenya for the first time, suggests that targeting the school environment may be important in improving the uptake and retention of HIV care by adolescents.

"That's why we are starting out with a qualitative methodology, to better understand what is going on," says Wolf. "When I was in Kenya last year I talked with health educators and medics and found that one of the major issues for school-going adolescents is stigma. I'm interviewing school educators to get a better sense of how stigma, disclosure, school policies, and other aspects of the school environment may impact HIV+ adolescents' risk for LTFU, in hope of doing a partnership with schools to make lives for HIV + adolescents better."

Dr. Wolf would like to acknowledge the ongoing support and collaboration of: Drs. Elizabeth Bukusi, Craig Cohen, Kawango Agot, Colette Auerswald, and Bonnie Halpern-Felsher, They are respectively based at the Kenya Medical Research Institute (KEMRI; Dr. Bukusi), Family AIDS Care and Education Services (FACES; Drs. Bukusi and Cohen), Impact Research and Development Organization and Tuungane Youth Transition Centre (IRDO and TYTC: Dr. Agot); and UCSF (Drs. Cohen, Auerswald, and Halpern-Felsher).

FACES is a family-oriented HIV prevention, care and treatment program and collaborative effort between KEMRI and UCSF. TYTC is a youth-oriented HIV prevention, care and treatment clinic run by IRDO in collaboration with FACES.