Garcia Quesada, Maria

School of Public Health



Senegal-Leveraging Adaptive Implementation Strategies to Achieve Universal Coverage of Antiretroviral Treatment in Senegal

The overarching goal of this study is to assess the feasibility, fidelity, and cost-effectiveness of a universal coverage of Antiretroviral Treatment (ART) intervention among individuals living with HIV who are not virally suppressed in Dakar and Ziguinchor, Senegal. 

PI Mentor: Stefan Baral

I’ve had the opportunity to travel a fair amount, including to several developing countries, but I’d never been anywhere in Sub-Saharan Africa before arriving in Senegal for my practicum. Maybe because Dakar has a fairly large expat community, or mostly likely because Senegalese people are so open and welcoming, I was surprised to very quickly feel at home. Everyone at the office, and anyone else I met, went out of their way to make sure I had what I needed. They made sure that I knew how to bargain for a fair taxi fare, that I knew where to get lunch and where to go grocery shopping, and that I knew where to enjoy the best ocean sunset views with a cold bissap(local hibiscus drink). They made it so adapting to the city that would be my home for the next five months was almost too easy. 

Although the most widely spoken language in Senegal is Wolof, speaking French (the official language) was definitely key to being able to adapt so quickly. Most Senegalese people speak at least basic French, which allowed me to quickly become independent, really get to know my coworkers, and get involved in the city. Namely, I joined the local capoeira club, which is an Afro-Brazilian martial art that I’ve been practicing for several years. Through this club I became friends with not only several Senegalese people, but also with people from all over west and central Africa. It gave me an opportunity to simultaneously stay in shape while learning about the local and regional cultures. Plus, we all went salsa dancing every Friday which quickly became one of my favorite Dakar activities.

During my practicum I primarily worked on two projects. The first was a study called Leveraging Adaptive Implementation Strategies to Achieve Universal Coverage of Antiretroviral Treatment in Senegal. My role included performing data cleaning and preliminary analyses, participating in the development of the intervention and associated SOPs, assisting with the case manager trainings, and developing and coding questionnaires. I had the opportunity to collaborate with our colleagues at the local NGO Enda Santé, all of whom have extensive field and research experience. They gave me important insight on the way the local context and culture impacted our study, and on how to approach challenges in a culturally sensitive way. 

The second was a project funded by USAID called Ending Aids in West Africa (#EAWA), which is a collaboration between JHU, Enda Santé, and FHI360. The goal of #EAWA is to accelerate progress in the region towards the UNAIDS 90-90-90 targets by focusing on improving the HIV care cascade among Key Populations in Togo and Burkina Faso. As a part of this project, I helped design and conduct a systematic review of literature on HIV interventions in Sub-Saharan Africa, and I participated in the development of trainings, project activities, and associated documentation. I also had the opportunity to travel to Togo and Burkina Faso to recruit a local project coordinator and to assist in the development and implementation of a capacity assessment of HIV organizations and associations in the area. I returned to Togo a second time to attend the 4thregional Key Populations Meeting, and then attended the Journées Scientifiques du SIDA au Sénégalconference in Dakar.

I traveled a lot more than I expected to, only spending about half of my practicum in Dakar, which was exhausting but incredibly enriching. It gave me a much better understanding of the region and the vast diversity within it. Furthermore, it gave me the opportunity to participate in programmatic work in addition to research, and it exposed me to the exciting and frustrating aspects of both types of work. During my trips to Togo I experienced the importance of strategic collaboration between different organizations, and how much seemingly internal issues can impact the outputs of a project. I also witnessed how much work goes into building a trusting relationship with the local community and its leaders, and I saw the direct impact of that relationship on the success of a research project or program. 

Living in Dakar was a delight and working with my colleagues from the local Baltimore team and at the NGO Enda Santé was a privilege. This experience may have broadened rather than narrowed down my interests, but I am confident that I am much better prepared to enter the global health field because of it. 


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

Robert Bollinger Jr., MD MPH

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

Caitlin Kennedy, PhD MPH,BA

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

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

August 2019




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