Yeh, Ping (Teresa)

School of Public Health

MSPH, Social and Behavioral Interventions

Tanzania

Tanzania - Testing innovative biological, social, and structural interventions for HIV prevention in rural Tanzania

There are two ongoing research projects funded by the National Institute of Mental Health currently underway in Kisarawe, Tanzania. One study, referred to as the "Triage Project," is testing the efficacy of a locally-run rural Prevention Center that offers testing for HIV and several non-communicable diseases, incentives to refer sexual partners for HIV testing for participants identified as "high-risk" or HIV-positive, and support groups and income generating activities for participants who test HIV-positive. The 18-month intervention began in November 2014. The second project, called the "Dyadic-based Diagnosis, Care, & Prevention (DDCP) Study,"  involves offering HIV self-testing to couples living in Kisarawe town, and for those who are found to be in an HIV-serodiscordant relationship, offering pre-exposure prophylaxis (PrEP) to the HIV-negative partner and early anti-retroviral treatment (ART) to the HIV-positive partner. This intervention has received funding and is expected to begin in Spring  2015. There is also a 3rd study being developed for the same site in Tanzania for NIH funding addressing integration of HIV screening with screening for non-communicable diseases (diabetes, hypertension, kidney disease). If funded, this study would also offer opportunities.  

Global Health Mentor:

Michael Sweat, Professor, International Health (JHSPH) and Department of Psychiatry and Behavioral Sciences (MUSC)

I had an amazing GHEFP experience in Tanzania last fall. Why? The presence and guidance of Dr. Virginia Fonner – who was not only one of the co investigators on the project I was working on but also the former project coordinator and a newly minted graduate from Hopkins's International Health SBI PhD program. Dr. Michael Sweat (my PI) and Ginny and I had skyped several times over the spring and summer, going over logistics and project plans. We decided that we could engineer the easiest transition and travel arrangements by arriving in Dar at the same time. This way, she could show me the ropes: introduce me to key people (project staff, drivers or other transportation-enablers, outside-of-work friends), jump-start my mental “important places and how to get there” map (the hospital, rural project site, landmarks, roads, shops, phone/internet vendors, fruit and vegetable markets, restaurants, church, options for housing), and generally orient me to the project and its standard operating procedures. Ginny allayed my initial nervousness, helped me start forming a social network in this place so different from home, and was the key to my smooth adaptation to a new language and culture. For her, and for prescient planning, I am supremely thankful.

The most important thing I learned about working in the field of global health is to be flexible. Coming from the US – especially as a student – I think it is easy to carry a subconscious sense of entitlement. The project should be how it was described, the scope of work should follow the established memorandum of understanding, housing and travel should be arranged, and so on and so forth. These are all important, nigh essential, discussions to have before embarking on an internship.

However, we live and work in a world that very rarely follows the plans we have dictated. The unexpected IS the norm. And so, while it is important to make plans, we should hold those plans as just that – guidelines for how we hope things will happen but with the expectation that things will change and that everything will be alright. Sometimes it means being okay with delay. Sometimes it means asking around the office for work, or helping out with the not-so-glorious “grunt” work of data entry or file organization or tracking down people for meetings or collating supplies or cleaning workspaces or troubleshooting equipment. (There should never be a shortage of things to do, if your eyes are open!)

There is usually a bright side even to the most mundane work. Shadowing site visits gives a taste of work out in the community. Sitting in on meetings with health officials, key informants, or ethical committees creates opportunities to network or better understand your project’s context. File organization enables other staff to build a more efficient workflow. And if there is – for example – a presidential election during your visit, and all roads and worksites are shut down for a week, it is a good idea to have found work that can be done remotely via the computer. Most valuable of all, I found, was this: willingness to go outside of the typical white-collar “public health professional” scope of work also helps build stronger relationships, because your co-workers in the field can trust that you are there for the long haul, not just for a quick check-in or for the glory of a publication. In these ways, GHEFP deepened my humility, openness, and flexibility.

Prevention Center sign, explaining our purpose and hours;

Nurse counselors after mobile HIV screening in the community;

Sharing research findings with the project field staff;

Field staff and supervisors at weekly debrief meeting;

Field staff and supervisors at the Ishi Huru Prevention Center;

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