Abrams, Elizabeth

School of Public Health

MSPH

Zambia

Zambia-Project YES! Youth Engaging for Success (HIV+ youth transitioning to adult HIV care)

This position is a great opportunity to work with HIV+ youth and a committed research team in Ndola, Zambia. As adolescents and young adults living with HIV age into adulthood, they must navigate the transition to HIV self-management and adult care. This is a complex process, particularly for young people who must manage a chronic illness like HIV. Routine viral load data from Arthur Davison Children's Hospital (ADCH) in Ndola, Zambia revealed that approximately 50 percent of youth have VL failure (~1,000 copies/ml), underscoring the urgent need for new strategies to assist this population in adhering to care and treatment. 

The study is a randomized controlled trial (RCT) at the individual level that uses a stepped wedge design to test a six-month peer-mentoring program among 144 youth in an intervention arm compared to 144 youth in a comparison arm. After the initial six months, the comparison group will receive the intervention. Assessments, including a survey and a blood draw for VL testing, will occur at baseline, at the end of the first six months, and at the end of 12 months. Resistance testing will also be conducted at baseline for those participants who have VL failure. After the first six months we will also conduct qualitative in-depth interviews with participants who were randomized to the intervention arm, their caregivers when possible, and the health care providers and peer mentors involved in the program. This data will provide contextual details and experiences to help interpret the study findings and determine what aspects of the intervention were valued by participants.

PI Mentor: Julie Denison

My time in Ndola, Zambia was a learning experience in a multitude of ways. In addition to being immersed in a rich culture, I had the opportunity to practice the Bemba language, experience real-world barriers that influence important projects, and balance many aspects of a multi-component intervention being implemented by a diverse team.

I worked with Project YES! Youth Engaging for Success!, a randomized-controlled trial testing the impact of a peer-mentoring intervention on HIV outcomes among youth in Ndola, Zambia. I worked under the instrumental mentorship of my advisor and the project P.I., Dr. Julie Denison; the project research coordinator, Virginia Burke; and local team members.

My work in Ndola helped me synthesize learnings formed over the past year in the Social and Behavioral Interventions program – my courses about health behavior change theory, community engagement methods, community health worker roles, and infectious disease pathogenesis informed my daily work. One situation in which this was most evident involved changes in patient drug regimens. Some youth had viruses that were resistant to one or more of their ART drugs, so they needed to change medicines. This involved communication among health care providers who were at times reluctant to alter a patient’s drug regimen without first ensuring the youth had reliable adherence practices; youth peer mentors who discussed adherence with their clients; caregivers who supported youth in taking their medicine; and youth themselves. Drawing on my Health Behavior Change course, I thought about how theoretical frameworks informed these multifaceted approaches to improving adherence. My community engagement courses had emphasized that this situation necessitated perspectives from youth themselves. Employing youth peer mentors to talk with participants about adherence was likely more effective than having an HIV-negative adult deliver the same message. Meeting youth where they were was key – encouraging them to move directly from missing doses to maintaining perfect adherence would have been difficult. Instead, peer mentors, caregivers, and youth collaborated to facilitate a supportive environment for youth to take steps toward improved adherence, reducing the likelihood of viral load failure and resistance to ART medicines.

The Project YES peer mentors worked at ART clinics, and we worked closely with health providers. I used skills from my qualitative research theory, methods, and practicum courses to help develop an in-depth interview guide for health providers to learn their perceptions of each component of the study. I conducted 10 interviews with the providers and am analyzing those data for my MSPH capstone, which I plan to develop into a publication.

Some of the most interesting, though at times challenging, days in the field were spent working with our team to translate our materials. Translations were rarely straightforward, and we went back and forth trying to ensure understanding of the concepts was similar in both the English and Bemba versions. The small amount of Bemba I had learned helped us recognize one of these points where interpretations differed; working through that experience taught me about patience and persistence, staying at the table until mutual understanding is reached.

Aside from work, much of my time revolved around some aspect of a meal – whether that be starting days with a cup of tea and breakfast while running my Bemba sentences by my (very patient!) colleagues to improve my language skills; learning to cook nshima and other Zambian meals while trading stories from past experiences; having a small braai with a friend toward the end of my time in-country; or the remarkable meal my colleagues prepared on my last day in the office, I recognized the seemingly universal power of sharing a meal, coming to the table with other people. Meals were places to share stories, learn about one another, ponder big questions, laugh, and simply enjoy each other’s presence. No matter where I go, there is something about sharing a table with someone that makes it feel like “home.” I am grateful for the tables I was welcomed to in Ndola, and I continue to integrate those experiences with my personal and professional involvement since returning to the U.S.

 

People

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation
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August 2019

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