Global Health Day robert j. havey, md institute for global health

Thank you for joining us!

The Havey Institute for Global Health's annual Global Health Day event is an exciting opportunity to draw together global health researchers, educators, and students to celebrate and discover more about global health research, education, and outreach efforts throughout our Northwestern community, Chicago, and beyond.

The event includes a poster and presentation showcase where students, faculty, community members and partners present on projects relevant to global health.

You can view the posters and abstracts below. (Abstracts are listed alphabetically by first initial of first name of participant who submitted)

Validation of the Sexual Relationships and Activities Questionnaire (SRA-Q)‚ In Burkina Faso, West Africa

Background: Sexual health and well-being (SHWB) is a critical component of overall physical, mental, and emotional health. However, research on SHWB remains limited in many low- and middle-income countries (LMICs), particularly in the West African region. This study aimed to validate the Sexual Relationships and Activities Questionnaire (SRA-Q), a measure of SHWB among middle-aged and older adults, using data from a 2021 aging study conducted in Nouna, Burkina Faso. Methods: The SRA-Q consists of 21 questions across five domains regarding subjects such as sexual activities/concerns and partnership satisfaction, 9 of which are sex-specific. Part of the larger Centre de Recherche en Santé de Nouna's (CRSN) 2021 Heidelberg Aging Study (CHAS), examiners verbally administered a linguistically and culturally adapted version of the SRA-Q to a sample of 2336 participants (56.8% Male; Mage = 53.2). A confirmatory factor analysis (CFA) was used to characterize the validity of the SRA-Q's theoretical model by analyzing goodness-of-fit indices (CFI, TLI, RMSEA) and factor loadings. Cutoffs for good model fit using these indices are ≥0.95, ≥0.95, and ≤0.06, respectively. Iterative testing was employed to refine the model, and refined models were then cross-validated through measure invariance testing to assess their stability and generalizability. Results: The original model yielded values below good fit thresholds for CFI, TLI, and RMSEA, respectively, and featured several poorly and/or negatively loaded factor loadings. Following model refinement, all goodness-of-fit index values improved significantly. Factor loadings all yielded positive values of equal or improved magnitude compared to the original model. Cross-validation of the refined models by measure invariance testing suggested good model fit and stability. Discussion: The original hypothesized model suggested a subpar fit, and factor loadings indicated that multiple items were redundant, irrelevant to their respective factors, or contained errors in their response scales. Refinements improved model fit, and factor loading values generally improved. These changes indicate that refinements successfully improved the SRA-Q's efficiency and validity for measuring SHWB, which may contribute to improving research tools for characterizing SHWB in the West African Region.

Presenting author: Alec Easter

Poster 1

Patient Experience and Perception of a Novel Financial Navigation Program on Cancer Care in Sub-Saharan Africa: Results from the COST-FIN Trial

Introduction: Financial toxicity is a leading barrier to cancer treatment in Sub-Saharan Africa (SSA), where most patients pay out-of-pocket and treatment abandonment exceeds 60%. The COST-FIN trial, the first randomized controlled trial (RCT) of a financial navigation program (FNP) in SSA, evaluates whether structured financial counseling reduces financial distress and improves treatment adherence. This sub-study examines patient experience and perceptions of the FNP. Methods: Adults (‚â•18 years) with newly diagnosed breast, prostate, or colorectal cancer at two Nigerian centers were randomized 1:1 to FNP or routine care. The intervention provided individualized financial literacy counseling, navigation of insurance/charity/drug-discount programs, and continuous navigator support. Patient experience was assessed at 3 months through structured satisfaction surveys and open-ended feedback. Responses were analyzed descriptively. Results: Early participants who completed the 3-month survey reported uniformly positive experiences with the financial navigation program. All strongly agreed that the program improved their understanding of available financial resources, facilitated access to assistance, reduced financial worries, and addressed issues important to them. Participants noted improvements in quality of life and consistently rated their overall experience as "better than expected." All indicated they would participate again and recommend the program to others. Qualitative feedback highlighted the program's emotional impact. One patient described the navigator's support as having "made my heart lighter" and preventing treatment abandonment, while another reported the program was "very, very good" and life-changing. No negative feedback was reported. Conclusion: Preliminary findings suggest that financial navigation is highly acceptable, valued, and supportive for cancer patients in Nigeria. Patients reported reduced financial and emotional burden, greater confidence in navigating costs, and improved quality of life. These results highlight the promise of financial navigation as a patient-centered approach to strengthen cancer care in resource-limited settings. Ongoing analysis with larger enrollment will determine broader impact on financial catastrophe, distress, and treatment adherence across SSA.

Presenting author: Alex Horowitz

Poster 2

Evaluate the Effect of Inadequate Representation on Dermatology Education and its Impact on the Quality of Care for Patients of Color

The concepts of diversity and representation are important in all career fields, but it is especially important in medical fields. In medical fields, treatment is dependent on the patient population and what and to whom the physicians are exposed to. Some medical fields suffer more than others as a result from a lack of diversity and representation. For instance, the field of dermatology is severely lacking in diversity, and it significantly affects their outcomes. There are various disparities that come with this lack of representation such as reduced patient outcomes and decreased quality of care. Education is a large part of solving and eliminating these disparities and increasing patient outcomes and the quality of care. This research analysis gathered data from various research papers to identify dermatological disparities within education. Once these disparities were identified, the papers were further evaluated to propose solutions for improving patient of color outcomes and their quality of care. This research examines how the treatment of patients of color is impacted by the lack of diversity in dermatology education. To achieve this, it assessed the quantity of dermatology-related physicians, text materials, clinical trial participants, and the degree of diversity inclusion. It also identified and proposed solutions to diversify dermatology by means of education. Based on the data and analysis conducted it is feasible to draw the conclusion that there is a general lack of diversity in dermatology education, which negatively affects patient outcomes and care quality.

Presenting author: Alexa Rowe

Poster 3

Got Milk? : Exploring Developmental Origins of PCOS Through Breastmilk Biology

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder affecting 7–10% of women of reproductive age, associated with adverse reproductive outcomes and long-term metabolic risks, including type 2 diabetes. Although typically diagnosed post-puberty, emerging evidence suggests that the mechanisms of PCOS may originate during critical developmental periods, including fetal and early postnatal life. Nutrition, particularly through human milk, plays a vital role in early metabolic programming, yet no studies have examined the composition of breastmilk in women with PCOS or its potential influence on offspring outcomes. This study aims to investigate whether human milk composition and lactation patterns differ in women with PCOS compared to controls, and whether these differences may contribute to early metabolic and reproductive phenotypes in daughters. A total of 120 women with PCOS and 120 control participants will be recruited, along with their daughters, and followed through 24 months of age. Milk samples collected at 3 and/or 12 months postpartum will be analyzed for macronutrients (protein, carbohydrate, fat, energy), glucose and lactose (via YSI analysis), insulin (via ELISA), and steroid hormones (via LC-MS/MS). Breastfeeding practices and lactation outcomes will be assessed using validated survey tools. We hypothesize that breastmilk from mothers with PCOS will show altered macronutrient and hormonal profiles, including higher fat and insulin content, and that these mothers may experience reduced breastfeeding success. This research will be the first to explore the relationship between maternal PCOS and human milk biology. Findings will provide critical preliminary data for understanding early-life nutritional influences on the developmental origins of PCOS and may inform future interventions aimed at improving metabolic health in offspring of affected women.

Presenting author: Andi Beaudouin

Poster 4

Elite and regional hospitals in North Korea: an investigation of hospital infrastructure from 2019-2024 using quantitative remote sensing analysis

Introduction The provision of electricity to healthcare facilities is problematic in the DPRK, with reports in the press suggesting that much procedural work must be performed in the dark or with flashlights. We designed a study of nighttime illumination satellite data from North Korea to answer two primary research aims. First, we aimed to determine whether hospitals appear to be prioritized over non-hospital sites in the limited energy delivery infrastructure within the DPRK, and whether this applies to elite hospitals, regional hospitals, or both. Second, we aimed to determine whether night illumination and darkness data across various dates could support or dispute claims about hospital uses, for example that a particular hospital was focused on elite patients or intended primarily as a showpiece. Previously, brightness in nighttime satellite data has been used to evaluate improvements in infrastructure associated with health and economic outcomes in North Korea. Our study builds on this by leveraging the high resolution of radiance data available from NASA to pinpoint specific sites for study. Methods We analyzed VIIRS VNP46A2 radiance data from 2019–2024 for 17 North Korean and 4 South Korean control sites. Locations included hospitals, residential areas, and elite institutions, classified by use-type and region (Pyongyang, Nampo, North Hwanghae, or South Korea). Metrics included mean radiance and coefficient of variation (CV), and statistical analysis included ANOVA with post-hoc Tukey HSD tests and pairwise correlations of temporal brightness trends between sites. We performed validation assays to demonstrate the functional resolution of the data for our application by analyzing light emission over concentric circles emerging from our targets, demonstrating that most targets appeared distinguishable as isolated sources in their surroundings. Results: Sites in Pyongyang exhibited significantly higher and more stable radiance than those in provincial regions (p < 0.001). No significant difference was found between hospitals and non-hospitals outside Pyongyang. Select Pyongyang hospitals—particularly Ponghwa Clinic and the Pyongyang Red Cross Hospital—demonstrated elevated brightness and unique illumination peaks poorly correlated with other city sites. These findings may be consistent with intermittent activation of prestige institutions. All South Korean hospitals showed consistently high, stable radiance with low CVs, helping to validate the method of inquiry. Conclusion: Our data is consistent with reports that healthcare access in the DPRK is shaped by political and social hierarchies, and that healthcare may be an important benefit for elites. Hospitals outside Pyongyang receive no apparent priority over residential zones, suggesting that regional hospitals are not prioritized over other energy uses amid severe scarcity. Conversely, some high-prestige Pyongyang hospitals are more brightly illuminated than other Pyongyang sites, suggesting that elite hospitals may be privileged over other elite sites. This supports the suggestion that healthcare is an important benefit provided to Pyongyang residents in particular. Nighttime satellite imagery may be useful as researchers work to understand the role of new hospital construction in the DPRK and the legitimacy of North Korean hospitals as centers of humanitarian relief.

Presenting author: Andrew Holzman

Poster 5

TGF-β Enforces HIV Latency via Suppression of Transcriptional Elongation

Globally, more than 40 million people have HIV, with more than 1 million new infections occurring every year. Although advances in antiretroviral therapy (ART) have allowed people with HIV (PWH) to forestall the development of AIDS, the disease remains incurable and is associated with significant comorbidities due to residual viral gene expression and inflammation. This is due to the persistence of the virus in long-lived CD4+ cell types, including T cells and myeloid lineage cells, in a transcriptionally inhibited state. Collectively, these persistently infected cells are termed the latent reservoir, and are the principle biological barrier to HIV cure. Transforming growth factor beta (TGF-β) has long been implicated in the induction and maintenance of this latent reservoir. Primary cell models of HIV latency have utilized TGF-β to force infected T cells into a latent-like state of quiescence, and serum levels of TGF-β have been found to correlate with disease progression in PWH on suppressive ART. Recent work has also shown that the blockade of canonical TGF-β signaling reverses SIV latency in a rhesus macaque model of ART-suppressed HIV infection. Here we demonstrate that TGF-β attenuates the action of canonical latency reversal agents in cell line models of HIV latency, including myeloid cell lines as well as the T cell line JLat 5A8. Different latency reversal agents are impacted by TGF-β to varying degrees, with the class of latency reversal agents that disrupt the BRD4 complex (BRD4i) showing particularly strong responsiveness to TGF-β in myeloid cell lines. Given that BRD4 inhibitors have been found to reverse latency by increasing transcriptional elongation, this suggests that TGF-β attenuates latency reversal through a suppression of the transcriptional elongation activity of BRD4i. Indeed, qPCR with RNA collected from treated cells demonstrated that TGF-β significantly reduced the abundance of HIV long LTR transcripts during JQ1 treatment relative to DMSO control. Further work will investigate the specific pathways downstream of TGF-β signaling which are responsible for this suppression of transcriptional elongation in myeloid cells.

Presenting author: Ari Halle

Poster 6

Persistent Postpartum Hypertension in Low- and Middle-Income Countries: Toward an Integrated Care Cascade

Background: Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, are leading causes of maternal morbidity and mortality globally. The burden is disproportionately high in low- and middle-income countries (LMICs), where 94% of maternal deaths occur. While significant research has focused on the antenatal and intrapartum periods, the postpartum phase- particularly beyond the traditional six-week puerperium- remains underexplored. Emerging evidence indicates that persistent postpartum hypertension poses substantial risks for long-term cardiovascular disease, yet health systems in LIMCs are not yet designed to monitor or treat women adequately during this critical window. Objectives: This narrative review examines persistent postpartum hypertension in LMICs through two complementary lenses: social sciences in health (SSH), which foregrounds the psychosocial determinants of vulnerability, and health services outcomes research (HSOR), which provides tools to design integrated models of care. Together, these perspectives illuminate the need for a postpartum hypertension care cascade that bridges obstetric, primary care, and psychosocial services. Methods: A narrative review of recent epidemiological studies, cohort analyses, and health system assessments was undertaken, with particular attention to LMIC settings. The SSH framework was used to analyze psychosocial vulnerabilities- including poverty, maternal age, obesity, and postpartum depression- that heighten risk and complicate care. The HSOR framework was applied to adapt the hypertension care cascade, originally developed in the context of HIV, to the postpartum period. Findings: Data from Nigeria demonstrate that 22.3% of women with gestational hypertension and 61.1% of women with preeclampsia/eclampsia remain hypertensive six months postpartum, with similar prevalence persisting at one year. Psychosocial factors compound medical risk: high body mass index, advancing maternal age, food insecurity, and untreated depression all influence disease persistence. From a systems perspective, fragmented services in LMICs create gaps in care. Obstetric follow-up often ends at six weeks postpartum, at which point women are expected to transition into primary care. Yet many primary care clinics currently lack readiness to diagnose and manage hypertension, with some countries reporting readiness levels below 30% at the community level. This structural fragmentation contributes to loss to follow up and poorly controlled disease. Discussion: Persistent postpartum hypertension represents a syndemic intersection of pregnancy, chronic disease, and property. Addressing this issue requires moving beyond siloed methods of care towards integrated cascades that extend through at least one year postpartum. Such cascades should support women from screening and diagnosis through treatment initiation, disease control, and long-term retention and care, while embedding psychosocial supports. Lessons from HIV care models demonstrate that cascade frameworks can strengthen the linkage, continuity, and accountability across the health system. Importantly, policy and financing must prioritize postpartum women within broader NCD strategies, ensuring that cost-effective interventions such as antihypertensive therapy are accessible and affordable. Conclusion: Persistent postpartum hypertension is an under-recognized yet critical driver of maternal morbidity and mortality in LMICs. Developing integrated care cascades that bridge obstetric, primary care, and psychosocial services is essential to reducing maternal cardiovascular risk, strengthening NCD primary and secondary prevention, and advancing equity in global maternal health.

Presenting author: Arielle Bell

Poster 7

Beyond Borders

Organ transplantation in South Asia occurs within a complex social fabric where religious beliefs, cultural norms and family backgrounds shape the attitude towards donation (Saxena, 2023). Understanding these factors among South Asia's diverse faiths is essential for culturally sensitive transplant practice. Addressing these influences could increase donation rates across Hindu, Muslim, Buddhist, Sikh, Christian, Jain, and traditional faith communities. This abstract will focus on the research done on the cultural and religious misconceptions within the field of transplant surgery throughout South Asia. The research focuses on major South Asian faiths, including Hinduism, Islam, Buddhism, Sikhism, Christianity, and Jainism (Mithra et al., 2013; Fatima et al., 2022). Ethnographic accounts, religious texts, public health studies, and community-based research are conducted across these countries to explore how cultural and religious frameworks shape attitudes towards organ donation and transplant Local traditions and interpretations of bodily wholeness, death, and organ donation are also considered. Sources include qualitative interviews and surveys of public opinion are taken from patients, families, and religious leaders. By comparing narratives from different communities and highlighting points of both convergence and divergence, the study aims to capture the lived realities of families faced with transplant decisions, rather than relying solely on scriptural interpretations. Religious and cultural beliefs influence how communities understand the importance of keeping the body whole, perform death rituals, and decide whether altering the body after death is acceptable. In many Hindu communities, traditional beliefs that emphasize the importance of karma and keeping the body whole after death exist alongside modern and scriptural interpretations that view organ donation as a selfless and charitable act (). In Islam, views on organ donation often depend on how believers interpret the sanctity of the human body and the idea that life and death are determined by God's will (Joseph, 2024). Many modern Islamic scholars and religious authorities support organ donation, especially when it can save or improve lives, seeing it as an act of service. However, some communities remain hesitant about procedures that involve altering the body after death, as they believe the body should be returned to God in the same state it was given otherwise it doesn't reach the afterlife (Akbulut et al., 2020; Saleem et al., 2009). Buddhist emphasis on compassion and non-harm is frequently interpreted as supportive of donation, though concerns about ritual completeness can arise (Joseph, 2024). Sikh teachings that foreground selfless service are generally favorable, whereas Jain emphasis on non-violence produces more ambivalence (Joseph, 2024). Christian communities often frame donation as an act of love, but it depends on local pastoral guidance as well (Joseph, 2024). Overall, it can be concluded that religious doctrine alone does not predict people's attitudes. Factors such as local interpretations of religious leaders, generational practices and beliefs, and the transparency of the safety of transplant practices, and family-centered consent models are recommended to align medical practice with community values and to ethically expand donation in South Asia (Mithra et al., 2013; Fatima et al., 2022).

Presenting author: Arthi Dutta

Poster 8

Demographics of pediatric trauma at a zonal referral hospital for northwestern Tanzania: a cross-sectional study

Introduction: Despite a high burden of pediatric injury (25% of all presenting injuries) in Tanzanian studies, literature remains limited, especially in recent years, regarding detail of care provided for the injured child across different healthcare settings in the country. This study aims to understand and map the pediatric trauma burden and factors descriptively associated with pediatric injury at the zonal referral hospital, Bugando Medical Center (BMC), for northwestern Tanzania. Methods: This study was a subgroup cross-sectional analysis of pediatric (ages 0 through 17) data collected from trauma patients who received care at BMC from March - August 2023, focused on pediatric-specific injury occurrence, injury characteristics, and location. Descriptive analyses of pediatric patient demographics, past medical history, prehospital characteristics, and injury characteristics across body system were conducted to understand the burden of serious injury in this setting. Geospatial analyses across region were conducted to understand patient density, triage level, prehospital care, and Euclidean distance from injury region to BMC. Results: 146 children were included in analysis. Almost all children were injured at home (42.5%) or in a traffic crash (33.6%), with more than half (56.8%) in the highest (red) triage category. Nearly 70% had received prehospital care from a healthcare professional. Head and HEENT injuries were most the most common. Distance from Bugando Medical Center was associated with higher triage level but not with prehospital care. Discussion: Pediatric injury in this referral hospital in northwestern Tanzania has distinct variations in referral patterns, injury locations and injury types. Efforts are particularly needed for head and HEENT emergency support due to the predominance of injuries to these body systems. Regional variations in pediatric trauma incidence may represent a future target for outreach from this referral institution.

Presenting author: Arthi Kozhumam

Poster 9

Quantitative HBsAg Levels Among Individuals With HBV and HIV/HBV Coinfection in Nigeria

Introduction: Globally, over 250 million people are chronically infected with HBV and at risk of developing cirrhosis and hepatocellular carcinoma. HBV is highly endemic in sub-Saharan Africa, with Nigeria reporting prevalence rates in persons with and without HIV ranging from 9.2%-18.0%. Quantitative Hepatitis B Surface Antigen (qHBsAg) is a serum marker of HBV infection which can help assess the likelihood of spontaneous or treatment-induced HBsAg clearance, a marker of functional cure. It has not previously been characterized in persons with HBV and HIV-HBV co-infection in Nigeria. Methods: A cross-sectional analysis of baseline data was conducted among a subset of participants with chronic HBV with and without HIV from University College Hospital (UCH) in Ibadan, Nigeria, enrolled in a longitudinal observational cohort study of liver disease (H2Net). Participants were enrolled into three participant groups: Grp 1: HBV on treatment (HBV OT), Grp 2: HBV treatment naïve (HBV TN); and Grp 3 HIV/HBV co-infected (HIV/HBV). Serum qHBsAg was quantified by electrochemiluminescence using the Cobas e 411 analyzer. Linear regression was utilized to examine associations between qHBsAg and HBV DNA, liver stiffness (measured by FibroscanTM transient elastography (TE)), HIV and treatment status. Data analysis was conducted in Stata 18. Results 195 participants were included in this analysis [HBV OT 88 (45.1%), HBV TN 60 (30.8%), HIV/HBV 47 (24.1%)]. Mean (SD) age was 44 (13) which differed across groups, with the highest age in HIV/HBV and lowest age in HBV TN. Most participants (91.3%) were HBeAg negative. Median log qHBsAg level was 4.37 IU/mL which differed across groups, with the highest levels in HBV mono-infected (TN and OT) and lowest in HIV/HBV co-infected (p< 0.05). Median (IQR) duration of anti(retro)viral treatment was longer in HIV/HBV (164 (120) months) vs. HBV OT (40 (57) months); p < 0.01). In multivariable analyses, HIV-positive status was associated with significantly lower qHBsAg levels (β = –0.28, p = 0.02). Log HBV DNA was also inversely associated with qHBsAg (p< 0.05). This association remained significant when restricting analyses to HBV mono-infected participants alone (TN vs. OT). Neither TE score nor treatment status was associated with qHBsAg. Conclusion: Quantitative HBsAg levels were high in this cohort of individuals with HBV and HIV/HBV coinfection in Nigeria, exceeding levels reported in other cohorts from sub-Saharan Africa and high-income countries. Participants with HIV/HBV coinfection had lower qHBsAg compared to those with HBV mono-infection, consistent with higher rates of HBsAg loss previously observed in this population. In this largely HBeAg-negative cohort, HBV DNA levels correlated poorly with qHBsAg. These findings provide important insights that will inform strategies for HBV monitoring and management in high HBV prevalent settings.

Presenting author: Bethann Conover

Poster 10

Age Friendly Services Provision for Older Adults in Rwanda's Primary Healthcare System: An Analysis of Healthcare Facilities and Providers' Perspectives

Ensuring the effective provision of age-friendly healthcare services (AFHS) is critical for addressing the needs of older adults, yet gaps remain in the health systems in Africa. This study examined primary healthcare facilities (PHFs) and providers' readiness in delivering AFHS in Rwanda. Data was collected from 24 PHFs and 180 providers in the Burera, Nyarugenge, Kicukiro, and Gasabo districts, using surveys developed based on WHO's age-friendly toolkit. The facility readiness survey gathered information on training, service availability, health assessments, and facility design, while the Knowledge, Attitudes, and Practices (KAP) survey captured data on providers' demographics and professional experience. Data were analyzed using descriptive statistics and multiple linear regression analysis We found that facilities were inadequately prepared to provide AFHS. Only 12.5% of facilities had staff trained in geriatric care, 8% had a worker to help older adults and 4% had a special consultation section for them. Furthermore, no facilities had budget or cost reductions for elderly patients. Many facilities lacked infrastructure features such as grab bars (13%) and accessible toilets (46%). Two-thirds of them did not assess hearing ability, and 29% did not assess vision. Providers' knowledge was generally good, with training and experience caring for older patients associated with better practices (p=0.001) and (p=0.008), respectively. Providers' attitudes were positive, especially among those who had cared for older family members (p= 0.035). Healthcare providers were positive about AFHS; however, work is needed to increase facility readiness and their knowledge and practice to increase diagnosis, prevention and management of geriatric conditions. Keywords: Facility readiness, KAP, Ageing, Rwanda

Presenting author: Callixte Cyuzuzo

Poster 11

Inflammation, Metabolic Syndrome, and CVD Risk in Older PLWH in Tanzania

Background: Aging is associated with increased risk of non-AIDs related comorbidities including MetS and cardiovascular disease (CVD). Despite the growing population of older persons with HIV (PLWH) in sub-Saharan Africa, screening for cardiometabolic diseases is rarely conducted. In this study, we characterized the distribution of metabolic syndrome (MetS), MetS severity (MSSS), and CVD risk scores and examined their associations with circulating biomarkers of inflammation (IL-6, sCD14, and VCAM-1) in an urban cohort of older PLWH in Tanzania. Methods: We conducted a cross-sectional analysis among a subset of participants >50 yrs enrolled in the Tanzanian HIV and Aging Longitudinal Cohort Study (THALCS). MetS was defined as: central obesity (ethnic-specific waist or BMI≥30 kg/m²) plus ≥2 of TG≥1.7 mmol/L, sex-specific low HDL, SBP≥130 or DBP≥85 mmHg or treatment, and fasting glucose≥5.6 mmol/L or diabetes treatment. MetS severity was quantified using MSSS. CVD risk was stratified using WHO CVD. Group differences were assessed using χ² or Fisher's exact tests for categorical variables and Wilcoxon rank-sum or ANOVA for continuous variables. Multivariable models were adjusted for age and sex. Results: 160 THALCS participants were included in the analysis. The prevalence of MetS was 36% (95% CI: 29–44) and did not differ significantly across age groups 50–59, 60–69, and ≥70 years (p = 0.84). MetS prevalence was higher among women compared with men, but this difference was not statistically significant (42.5% vs. 30% p=0.1001). The most common MetS components were hypertension (67.5%) and central adiposity (61.9%). MSSS was highly correlated with MetS (r = 0.36, 95% CI 0.21–0.49, p < 0.001). Comparisons by sex and age revealed no consistent differences in MetS components. Mean MSSS was higher among women (p< 0.0076). Two-thirds of participants had moderate or higher CVD risk (WHO CVD 33% low; 45% moderate; 18.5% high risk; 2% very high risk). CVD risk was significantly higher in men vs. women (79% moderate or higher risk in men vs. 54%, p< 0.01). Overall, circulating biomarkers of inflammation were not significantly associated with MetS or elevated CVD risk. In MetS component-level analyses, VCAM-1 was associated with higher levels of hypertriglyceridemia (defined as ≥1.7 mmol/L; [p= .04]) and sCD14 was associated with higher fasting glucose levels (≥5.6 mmol/L or therapy [p=.010]); IL-6 was not associated with MetS components, MSSS, or CVD risk. Conclusions: MetS prevalence in this cohort was consistent with rates reported across sub-Saharan Africa. In contrast to cohorts from high-income countries (HICs), where central adiposity together with lipid and glucose abnormalities typically predominate, hypertension and central adiposity were the most common MetS components observed. MetS severity (MSSS) scores were higher among women, underscoring the need for sex-specific targeted interventions. Most participants had moderate-to-high estimated 10-year CVD risk, yet routine CVD risk assessment remains uncommon, highlighting an actionable care gap. Biomarkers of inflammation may be less helpful in this setting for predicting MetS and CVD outcomes.

Presenting author: Dannielle Grayer

Poster 12

Improving Stroke Care for Better Health Outcome in Sub-Saharan Africa: A preliminary Survey

Background and Aims: Stroke is a leading cause of hospitalization in Nigeria, where < 10% of hospitals have a functional stroke unit (SU), therefore limiting acute stroke care. As a potential high impact solution, low-resource stroke units (LRSUs) may be the answer to prevent stroke morbidity and mortality in lower-middle income countries (LMICs) of sub-Saharan Africa (SSA), while still following best clinical practices. Methods: A prospective observational study where consecutive patients were enrolled into the usual care phase (UC) predating the implementation of the LRSU phase of the study. The 'bottom up' and 'human capital' approaches were used to generate estimates of the direct and indirect costs respectively. Cost-effectiveness analysis (CEA) to determine the economic value of LRSU will be conducted from 'the hospital perspective'. Results: 202 patients were enrolled in the UC phase with a median LOHS of 8 days (IQR = 8). The median in-hospital cost (direct plus indirect) of care amounted to ₦187,808 (IQR: ₦95,651; Range: Min-₦72,167, Max-₦1,280,085) in those with ischemic stroke (n=102) and ₦182,495 (IQR: ₦116,141; Range: Min-₦84,087, Max-₦859,291) in those with hemorrhagic stroke (n=33). The median in-hospital direct cost for ischemic and hemorrhagic stroke was ₦153,470 (IQR: ₦107,113; Range: Min- ₦59,700, Max- ₦1,182,585) and ₦155,495 (IQR: ₦82,827; Range: Min-₦76,587, Max-₦511,181) respectively. Conclusions: The cost of care associated with the UC is high relative to affordability index (₦1,451 per adult per day) underscoring the need for implementing LRSU in our resource-constrained healthcare settings.

Presenting author: Dilip K Pandey

Poster 13

Genomic Surveillance and Phylodynamic Analysis of SARS-CoV-2 in Peru and Bolivia

SARS-CoV-2 genomic surveillance has been a valuable tool to monitor the dissemination and evolution of new variants that pose an increased risk to global public health. Rapid sequencing and data sharing has lead to the identification of variants with enhanced viral fitness, guided public health interventions and improved vaccine strategies. However, limited sequencing capacity in low- and middle-income countries (LMICs) create gaps in the global surveillance network. Through collaboration with the Universidad Nacional Mayor de San Marcos (UNMSM) in Peru and the Universidad Autonoma Gabriel Rene Moreno (UAGRM) in Bolivia, the Center for Pathogen Genomics and Microbial Evolution (CPGME) investigated the genetic diversity of circulating SARS-CoV-2 in South America from June 2022 and November 2024. Over 800 isolates from Santa Cruz, Boliva were collected and sequenced at Northwestern University, generating 517 whole genomes. Our analysis revealed that Bolivia experienced a period of 22E clade dominance in late 2022. Followed by a transition to clade 22F by early 2023. During a subsequent wave, emerging clades 24A, 23A and 23F rapidly displaced earlier lineages. Regression analysis identified lineages FE.1.1.1 to be over-represented in Bolivia relative to the broader South American region while lineage BQ.1.1 was under-represented. In Peru, 200 sequenced isolates were shared and analyzed alongside publicly available data to perform phylogenetic dynamics and investigate circulating lineages. Our analysis found the two most prevalent circulating clades between June 2022 to December 2022 were 22B and 22F. During the first half of 2023, there was a shift in prevalence to clades 22F and 23A. The presence of 23A would persist during the second half of 2023 and would be replaced by clade 24A. We also found two significant lineage expansions: the first in December 2022, seemingly driven by locally circulating variants rare elsewhere but common in Peru and neighboring countries; and the second in November 2023, primarily driven by globally dominant JN.1 lineages. Notably, within this second expansion, we observed the localized spread of a distinct sub lineage, JN.1.42, concentrated in the Loreto region. These findings highlight the value of sustained genomic surveillance in underrepresented regions, emphasizing the need for continued efforts in local sequencing efforts to better detect and respond to emerging SARS-CoV-2 variants.

Presenting author: Dulce S. Garcia

Poster 14

Building Administrative Expertise in Grants Management: Results from a Capacity-Building Workshop in Uganda

Background: Uganda, a low- and middle-income country (LMIC), bears a substantial disease burden, with communicable diseases accounting for over 50% of national morbidity and mortality. Makerere University, the country's premier research-intensive institution, has emerged as a leader in scientific research. However, the rapid expansion in research funding has outpaced the capacity of its research administrators (RAs) and effectively manage grants. To address this gap, the University is enhancing research administration capacity through continuing education and targeted training supported by an NIH G11 award. From July 14–17, 2025, Makerere University and Northwestern University conducted a four-day workshop focused on strengthening administrative competencies across the grant's lifecycle—including pre-award, post-award, and closeout processes. Facilitators included research administration experts from both institutions, with sessions highlighting the role of Makerere's central grants office, Grants Administration and Management Support Unit (GAMSU). Methods: Pre and post-tests were implemented daily through Google Forms. The tests included unique identifiers to enable matched analysis to show individual knowledge gains. When individual analysis was not possible due to the data available, group-level analysis was done. Analyses methods used included: • Heatmap of self-reported knowledge vs. reported change: Participants rated their knowledge of specific topics (e.g., GAMSU office, grants lifecycle) before and after the training. Heatmaps summarized shifts in self-assessed knowledge, allowing group-level analysis even when individual pre-/post-matches were incomplete. • Multiple-choice questions and True/False: Identical pre-/post-test items were coded as correct or incorrect, with counts of participants who improved (wrong on pre-test, correct on post-test) calculated. Results: Analysis revealed that among matched participants (N=33), 89.3% reported an increase in knowledge of GAMSU of any type in knowledge of the GAMSU office. A heatmap gave additional detail, summarized self-reported knowledge before the workshop versus reported change after showing 14 participants that had 'a little' knowledge now had 'a lot more knowledge', and 7 participants that had 'some' knowledge now had 'a lot more knowledge'. Participants demonstrated clear knowledge gains on key skills related to software SciENcv. On the SciENcv true/false item, 18 of the matched participants (N=59) improved, correctly recognizing its purpose as biosketch creation. Improved understanding of approaching the peer review as part of the grant application process was shown through the multiple-choice question with 16 participants (N=58) improving from wrong to correct on the post-test. A heatmap showed knowledge for building budgets from start improved (N=22) with 19 participants that self-rated with 'some' knowledge on the pre-test, rating at 'A lot more knowledge' on the post. Conclusion: Matched analyses demonstrated individual improvements across multiple domains, and group-level analysis highlighted positive results in understanding aspects of grants administration. The evaluation data gives facilitators insight into areas that may need more detailed explanations on nuances, or live demonstrations – such as showing the NIH eRA Commons software system.

Presenting author: Elizabeth N. Christian

Poster 15

Assessing the Diagnostic Utility of Multimodal Large Language Models for Automated Ophthalmic Triage in Resource-Limited Global Health Settings

Large language models (LLMs) represent a transformative frontier in ophthalmic artificial intelligence, with the potential to extend diagnostic capacity beyond the constraints of conventional image classifiers by integrating multimodal reasoning. In this cross-sectional evaluation, we benchmarked four of the most advanced commercially available LLMs—ChatGPT-5 Pro (OpenAI), Gemini 2.5 Pro (Google), Claude 4 Opus (Anthropic), and Grok 4 Heavy (xAI)—against expert-defined clinical ground truth (CGT) for the detection of referable eye disease in a mobile mission cohort from Todos Santos, Mexico. Data included clinical vignettes, autorefractions, visual acuities, intraocular pressures, and handheld anterior and posterior segment images (n = 646, of which 282 [43.7%] met diagnostic quality criteria). Five pathologies were evaluated: cataract, pterygium, diabetic retinopathy (DR), glaucoma suspect, and age-related macular degeneration (AMD). Each LLM was assessed under two distinct input conditions: images-only versus images combined with a clinical vignette. Across all models, provision of clinical context substantially enhanced diagnostic fidelity, increasing sensitivity by a mean of 18.6% and F1 scores by 0.12, with modest tradeoffs in specificity (–6.4%). ChatGPT-5 Pro demonstrated the most clinically balanced profile in multimodal mode (sensitivity 0.71, specificity 0.82, F1 = 0.68, κ = 0.49), closely mirroring expert adjudication in DR and glaucoma suspect. Gemini 2.5 Pro preserved the highest specificity (up to 0.91) but systematically underdetected DR (sensitivity of 0.38), while Claude 4 Opus maximized sensitivity (up to 0.89) at the cost of a low positive predictive value (≤0.32 in AMD) and a high false-positive burden. Grok 4 Heavy occupied an intermediate position, favoring conservative specificity-driven outputs (κ up to 0.46 in glaucoma suspect). In contrast, image-only inputs resulted in significant reductions in sensitivity (averaging 22%) and failed to capture anterior segment pathology across all models. Overall, distinct diagnostic phenotypes emerged. Claude consistently overcalled disease, Gemini undercalled, Grok trended conservative, and ChatGPT most closely approximated CGT referral patterns. Taken together, these results demonstrate that state-of-the-art LLMs exhibit heterogeneous diagnostic "personalities" shaped by sensitivity–specificity tradeoffs, and that the integration of structured clinical context is indispensable for optimizing their performance. While none achieved accuracy sufficient for autonomous deployment, ChatGPT-5 Pro's balanced multimodal outputs suggest that LLMs are evolving into viable adjunctive tools for triage and referral support in global ophthalmic care. Realizing this potential will require continued model refinement with diverse, field-acquired datasets, advances in portable imaging quality, and rigorous translational validation, but the trajectory of progress positions multimodal LLMs as a paradigm-shifting force in equitable vision screening and disease detection worldwide.

Presenting author: Ethan James

Poster 16

Evaluating the Impact of Financial Navigation on Financial Toxicity in Cancer Care (COST-FIN): A Randomized Controlled Trial (NCT066309262)

Background: Financial hardship threatens cancer outcomes in Nigeria, where delayed diagnosis and treatment are common. Evidence for Financial Navigation Programs (FNPs) in low-resource settings is scarce. Methods Adults (≥18 years) newly diagnosed (≤6 weeks) with breast, colorectal, or prostate cancer at two Nigerian hospitals (Lakeshore Cancer Center, Lagos and Obafemi Awolowo University Teaching Hospital, Ile-Ife) were randomized 1:1 to receive financial navigation (FNP) or routine care (RC). Structured interviews were conducted at baseline, 3, and 6 months to collect demographic, treatment, and cost data. Financial distress (FD) was assessed using the 12-item FACIT-COST (0–44; lower = worse). Financial catastrophe (FC) was defined per WHO thresholds (10% income, 25% total expenditure, or 40% non-subsistence expenditure). Treatment adherence and insurance coverage were assessed by self-report. Arm-by-timepoint differences were analyzed using linear mixed-effects models (fixed effects: arm, timepoint, arm × timepoint; covariates: site, age, sex; random intercept for patient). Results: Among 149 participants (median age 55 years; 66% female; 63% with breast cancer; 28% with metastatic disease), delays in diagnosis and treatment were common, reported in 69% and 62% of patients respectively, primarily due to financial barriers. Only 16% of participants held health insurance, and 89% of cancer expenses were paid out-of-pocket, most frequently for drugs and treatment (57%). Analysis of financial distress showed that mean scores were similar across arms at baseline, with modest improvements observed in both groups by three months. The arm-by-timepoint interaction was not statistically significant (p = 0.37). However, financial catastrophe outcomes demonstrated favorable effects of financial navigation: at three months, the risk of high health expenditure (≥25% of household income) was lower in the FNP arm compared to routine care (OR ≈ 0.9, p = 0.02), and by six months, the risk of non-subsistence expenditure (≥40%) was substantially reduced in the FNP group (OR ≈ 0.01, p = 0.03). Importantly, no participants in the FNP arm reported discontinuation of treatment due to cost, compared to 16% in the routine care arm at six months (p = 0.05). Conclusion: Cancer patients in Nigeria face high rates of delayed diagnosis, delayed treatment, and financial hardship, with most expenses paid out-of-pocket. Interim results suggest that financial navigation reduces the risk of financial catastrophe and prevents cost-related treatment discontinuation, though early effects on financial distress were not significant. Continued follow-up to 12 months will clarify the sustained impact of FNPs on financial toxicity and inform strategies to mitigate financial hardship in low- and middle-income country settings.

Presenting author: George Gutierrez

Poster 17

An examination of parental knowledge, confidence, and intervention preferences related to adolescent HPV vaccination in Vietnam

Background: Human papillomavirus (or HPV) is estimated to be responsible for 620,000 cancer cases in women and 70,000 cancer cases in men globally (World Health Organization, 2024). In Vietnam, cervical cancer is the fifth leading cause of death in women (HPV Information Centre, 2023). The Vietnamese government has recently announced plans to introduce the HPV vaccine into the National Expanded Program of Vaccination for adolescent girls beginning in 2026 (Hoang, 2024). In collaboration with VinUniversity (Hanoi, Vietnam), our team is conducting a mixed-methods study to explore knowledge, confidence, and intervention preferences related to HPV vaccination among parents of adolescents in Vietnam. Method: This poster describes the sequential, exploratory mixed-methods design of the study and details progress to date of the initial quantitative phase of the study. Results: The setting for study recruitment will be the VinSchool, a school system with 54 schools with 48,000 students across three geographical regions of Vietnam (north, central, and south). Our study leverages an explanatory sequential mixed-methods design, where we first collect and analyze quantitative data on parents' current knowledge, confidence in, and barriers and facilitators related to HPV vaccine intention. In addition, we will collect and analyze qualitative data to build on the insights gained from the quantitative results and identify messaging preferences, trusted sources of information, and strategies to promote HPV vaccine confidence and uptake. In the summer of 2025, the quantitative survey was developed based on an extensive review of the literature. We used the Brislin model for translation and validation of instruments. In the fall of 2025, we will employ a stratified and clustered random sampling approach to select two to six classrooms from each of six schools in three regions for survey administration to parents of adolescents (n=1,440). Concurrently, the process of pilot-testing of interview questions will be conducted. Significance: Previous studies on HPV vaccination in Vietnam were largely conducted under the assumption that families would need to pay out-of-pocket for the full vaccine series. To our knowledge, this is the first study to examine parental barriers and attitudes toward HPV vaccination in the context of its inclusion in the National Expanded Program of Vaccination. Furthermore, by detailing the process of developing our research instruments and pilot-testing of interview questions, we highlight the critical logistical adaptations required when implementing global health research in cross-cultural settings. Works Cited: World Health Organization (WHO). (2024, March 5). Human papillomavirus and cancer. Accessed February 20, 2025. https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer HPV Information Centre. (March 10, 2023). Human Papillomavirus and Related Diseases Report. Accessed February 20, 2025. https://hpvcentre.net/statistics/reports/VNM.pdf Ha H. (2024, June 10). Heath ministry to add four more vaccines to Expanded Immunization Program. Bao Chinh Phu. Accessed February 20, 2025. https://en.baochinhphu.vn/heath-ministry-to-add-four-more-vaccines-to-expanded-immunization-

Presenting author: Huyen-Anh Giang

Poster 18

Prevalence and Factors Associated with Frailty Among Older People Living with HIV in Urban, Tanzania

Introduction: The population of older people living with HIV (PLHIV) is increasing globally due to improved HIV care and increased life expectancy, in Tanzania this population is expected to grow by 25% by 2040. Chronic infection and prolonged antiretroviral therapy (ART) use predispose this population to early-onset age-related conditions, including frailty. We investigated the prevalence of frailty and associated factors among older PLHIV in urban Tanzania. Methods: We conducted a cross-sectional analysis of baseline data from 400 PLHIV aged ‚â•50 years enrolled in the Tanzania HIV and Aging Longitudinal Cohort Study (THALCS) between April and July 2024. Frailty was assessed using the Fried Frailty Phenotype (FFP) tool. FFP scores ranges from 0-5; frailty is defined as ‚â•3; prefrail as 1-2 and not frail as 0. Multivariable ordinal logistic regression was performed using Brants test of proportional odds assumption to determine the factors associated with frailty. Results: In this cohort of the 400 PLHIV, [median age 57 (IQR: 53-63) 50% female], 240 (60%) were on ART for 110-19 years, 287 (72%) were virally suppressed (HIV VL< 50 copies/mL) 234 (59%) were hypertensive (BP‚â•140/90mmHg) and 203 (51%) were overweight/obese (BMI >25kg/m2). The prevalence of frailty was 14% and prefrailty 49%. The most prevalent FFP domains were low physical activity (35%) and weak grip strength (28%) while exhaustion was the least common 16%. Factors independently associated with frailty included female sex (adjusted odds ratio (aOR)=1.38, 95% CI: 1.31-1.45, p-value< 0.001), being at risk of social isolation (aOR=1.47, 95%, CI: 1.46-1.56, p-value< 0.001) being hypertensive (aOR=1.25, 95% CI: 1.12-1.39, p-value< 0.001), underweight (aOR=3.43 95% CI: 2.76-4.27, p-value< 0.001), overweight/obese (aOR=1.37 95% CI: 1.23-1.54, p-value< 0.001) and mild to severe depression (aOR=3.13, 95% CI: 1.39-7.08, p-value=0.005). Conversely, ART duration for ‚â•20 years was associated with 51% lower odds of frailty (aOR: 0.49, 95% CI: 0.39-0.62, p-value< 0.001). Conclusion and recommendation: Frailty and prefrailty are highly prevalent among older PLHIV in urban Tanzania. Female sex, social isolation and comorbidities increased the likelihood of frailty, while longer ART duration was protective. As the population of older PLHIV is increasing, it is crucial to integrate screening and management of geriatric conditions together with medical comorbidities.

Presenting author: Irene Robert Mageni

Poster 19

Evaluating the Association Between Baseline Food Insecurity and Financial Distress in Patients Undergoing Cancer Treatment in Nigeria: Results from the COST-FIN Trial (NCT06630962)

Introduction Cancer care imposes a significant financial burden on patients, particularly in low- and middle-income countries (LMICs), like Nigeria, where healthcare financing is largely out-of-pocket. Concurrently, over 40% of the population experiences food insecurity. With over 100,000 new cancer cases annually in Nigeria, the dual burden of limited food security and high treatment costs may worsen financial distress (FD). While the link between food insecurity and FD is well-documented in high-income settings, this relationship remains understudied in LMICs. This study explores the relationship between baseline food insecurity and FD among Nigerian patients undergoing cancer treatment. Methods In this prospective randomized controlled trial, adult patients (≥18 years) with a new diagnosis of breast, colorectal, or prostate cancer were enrolled within six weeks of diagnosis at a public and a private cancer center in Nigeria. A structured questionnaire was used to collect demographic, clinical, and socioeconomic data. Food insecurity was measured using the 2-item Hunger Vital Sign™, categorizing patients as food-secure (score 0), marginal/at-risk (1), or food-insecure (2). Financial distress was assessed with the 12-item FACIT-COST tool (score range: 0–44; lower = greater distress). Statistical analysis included the Kruskal–Wallis test, χ² or Fisher's exact test, Spearman rank correlation, and a univariable linear trend model (FACIT-COST ~ food-security score), with significance set at p < 0.05. Results Among 135 patients (median age 56; 65% women; cancer types: 64% breast, 21% prostate, 15% colorectal), 58.5% were food-insecure, 9.6% marginally insecure, and 31.9% food-secure at baseline. Financial distress worsened with increasing food insecurity (p < 0.001). Spearman correlation confirmed an inverse association (ρ = –0.41, p = 6.5 × 10⁻⁷). The linear trend model showed that worsening by one food-security level corresponded to a 4.3-point decrease in FACIT-COST score (β = –4.3 ± 0.8, p = 7.4 × 10⁻⁷), explaining 17% of the score variance (R² = 0.17). A corresponding gradient was seen in economic indicators: median personal income dropped from ₦79,500 ($52) (food-secure) to ₦50,000 ($33) and ₦48,000 ($31) (p = 0.018), while median household income declined from ₦185,000 ($121) to ₦90,000 ($59) to ₦50,000 ($33) (p = 0.002). Employment, cancer stage, age, and head-of-household status did not differ significantly across food-security groups (p ≥ 0.10). Conclusion Food insecurity was highly prevalent at diagnosis and strongly associated with financial distress in Nigerian cancer patients. Food insecurity is a clear early indicator of financial vulnerability during treatment. Routine screening for food insecurity could help identify high-risk patients and guide support services. These findings underscore the importance of integrating food and financial assistance into cancer care programs in low-resource settings to reduce treatment-related hardship.

Presenting author: Jane-Frances Aruma

Poster 20

Ageing and Hypertension but not HIV status Predicts Kidney dysfunction among Older Adults in Urban Tanzania: A Comparative Cross-Sectional Study

Background: Adults living with HIV (ALHIV) have more than a threefold increased risk of developing kidney disease compared to those without HIV. However, the risk among ageing populations with HIV, specifically, where risk factors such as hypertension and diabetes are more prevalent, is less well understood. Methods: We conducted a comparative cross-sectional study among older adults with HIV (AWHIV) aged ≥50 years in Dar es Salaam, from the Tanzania HIV and Aging Longitudinal Cohort Study (THALCS), and adults without HIV (AwoHIV) from the Dar es Salaam Urban Cohort Study (DUCS). Participants were matched 1:1 by sex and five-year age strata. Socio-demographic, comorbidity, and laboratory characteristics were compared between groups. The primary outcome was renal insufficiency, defined as an eGFR of < 60 mL/min/1.73 m2 according to the KDIGO (Kidney Disease: Improving Global Outcomes. eGFR was estimated from serum creatinine using the 2021 CKD-EPI equation and was used as a continuous outcome in a multivariable logistic that was used to identify factors associated with kidney dysfunction. Results: 800 study participants [400 AWHIV, 400 AWoHIV; mean (SD) age 59 (7) yrs were analyzed. A higher proportion of AWoHIV (63%) vs AWHIV (55%) were hypertensive (p=0.02). AWoHIV were also more likely to be pre-diabetic (37 vs 19%) and diabetic (16 vs 12%); p's < 0.01. There were no differences in mean estimated glomerular filtration rate (eGFR) (AWoHIV 77.6 ± 20.1 mL/min/1.73 m² vs. AWHIV 78.9 ± 20.7 mL/min/1.73 m²; p=0.4) or eGFR KDIGIO categories. In both groups, mean eGFR was lower in higher age groups (60–69 and ≥70 vs. age 50–59, p values all < 0.01). In multivariable analysis, participants aged 60 – ≤69 (aOR = 1.62, 95% CI: 1.04–2.53, p = 0.032), and those ≥70 (aOR = 5.13, 95% CI: 2.80–9.47, p < 0.001) had higher odds of kidney dysfunction vs those 50–≤59yrs. Hypertension was also significantly associated (aOR = 1.73, 95% CI: 1.09–2.73, p = 0.02) with kidney impairment, whereas HIV status was not. Conclusion: Kidney dysfunction was common among older adults, largely driven by age and hypertension rather than HIV infection. These findings underscore the importance of routine screening and management of non-HIV risk factors for kidney impairment in aging populations.

Presenting author: Jasmine Machhi

Poster 21

Co-Designing a Primary Healthcare Intervention to Improve Diabetes Care in Mendoza, Argentina: A Qualitative Case Study

Background: In low- and middle-income countries, primary healthcare (PHC) faces significant challenges in delivering effective care for chronic conditions, exacerbated by fragmented systems, resource limitations, and inequitable access. Despite national strategies for non-communicable diseases, implementation varies due to decentralised governance, leading to gaps in care. In Mendoza, these gaps manifest as long wait times, limited diagnostic capacity, and poor coordination between care levels, underscoring the need for contextually relevant solutions. Here we describe the codesign process of a contextually relevant intervention to strengthen diabetes care in Mendoza's PHC system. Methods: Using a qualitative case study approach, we conducted co-design workshops (11/2024 – 02/2025) involving patients, healthcare providers, and policymakers. Activities included user journey mapping, world café, and prioritisation exercises guided by the Implementation Research Logic Model (IRLM) and Normalisation Process Theory (NPT). We collected data from activities and were analysed using reflexive thematic analysis. Results: Thirty-eight stakeholders, including patients, healthcare providers, and policymakers, participated in a structured, theory-informed codesign process, which included six workshops. Using participatory techniques and activities, such as role play, journey mapping, World Café, participants collaboratively identified challenges and proposed solutions. These solutions translated to implementation strategies to improve diabetes care at PHC level. Participants collaboratively refined these strategies and planned their integration into practice. The final set of strategies included community-resource mapping and social prescribing, workshops tailored separately for patients and for families, training sessions for professionals, improvements to registries, protected appointment slots, and mobile phone–based reminders and tips. The process contributed to shared ownership of the project, cross-stakeholder learning, and problem-solving. Emotional engagement and creative exercises promoted collaboration and innovative problem-solving. The strategies resulting from the process emphasised stakeholder collaboration and systemic improvements tailored to local needs. The feasibility, acceptability and fidelity of implementation strategies are being tested in a four-month pilot in two PHC centres. Then, its effectiveness will be assessed through a cluster randomised trial throughout the province. Conclusion: This study shows that a structured codesign process can support the development of a context-specific intervention to improve diabetes care in PHC. The workshops enabled the identification of feasible implementation strategies that reflected diverse stakeholder perspectives and multi-level barriers. The co-design approach was feasible and well-received in this setting, offering insights for similar efforts in other contexts.

Presenting author: Javier Roberti

Poster 22

Classification and Prognosis of Portal Vein Tumor Thrombosis in South African Hepatocellular Carcinoma

Background Portal vein tumor thrombosis (PVTT) is a common complication of hepatocellular carcinoma (HCC) and is associated with poor prognosis. In South Africa, treatment guidelines adhering to Barcelona Cancer Liver Clinic (BCLC) guidance often treats any PVTT as a contraindication to curative therapy, defaulting many patients to best supportive care. The prognostic relevance of PVTT classification systems, such as the Cheng and Vp systems, has not been well studied in Southern African populations. Anatomic PVTT extent, graded by Cheng and Vp systems, was evaluated for prognostic value with the goal of informing more just, clinically nuanced treatment allocation. Methods This was a retrospective cohort study of HCC patients with PVTT diagnosed at Groote Schuur Hospital in Cape Town, South Africa, between 2013 and 2024. PVTT was classified independently by two reviewers using the Cheng (Type I–IV) and Vp (Vp2–Vp4) systems. Cox proportional hazards models stratified by cirrhosis and adjusted for Child–Pugh class and treatment group were used to evaluate associations with overall survival (OS). Kaplan–Meier curves and model-adjusted survival estimates were generated for each classification system. Results Among 173 eligible patients, most were male (70%) with median age 49 years; hepatitis B was the predominant etiology (63%). PVTT distribution was Cheng I–IV: 6.5%, 42.0%, 27.8%, and 23.7%; Vp2–Vp4: 6.5%, 41.4%, and 52.1%. Treatments included supportive care (n=120), locoregional (n=35), systemic (n=11), and curative (n=7). On multivariable analysis, PVTT extent was not independently associated with OS (Cheng global p = 0.200; Vp global p > 0.900). Model-adjusted survival generally declined with increasing PVTT extent, but differences attenuated after adjustment, and the most advanced PVTT categories did not consistently confer the highest mortality risk. Hepatic reserve and treatment modality were dominant prognostic factors of OS. Median unadjusted OS by treatment was 643 days (curative), 282 (locoregional), 168 (systemic), and 54 (supportive) (log-rank p< 0.001). Conclusions In this Southern African cohort, liver function and treatment modality, not PVTT extent independently, were the dominant prognostic factors in HCC with PVTT. While PVTT classifications had limited independent prognostic value, it remains clinically relevant for guiding treatment selection, particularly when integrated with hepatic reserve and performance status. These findings challenge blanket exclusions of patients with any PVTT from curative-intent pathways and instead suggest PVTT extent-based frameworks (Cheng/Vp) alongside assessment of hepatic reserve could ethically expand eligibility for active treatments.

Presenting author: Jeffrey Blibo

Poster 23

Development of a Rapid Automated Point-of-Care Test for Hepatitis C Viral RNA on the DASH® Rapid PCR System

Hepatitis C virus (HCV) infection is a major public health problem despite the availability of highly effective and curative direct acting antiviral (DAA) treatments. Low diagnostic rates, driven by a two-step diagnostic process and the need for molecular confirmation, pose a significant barrier to timely treatment. While detection of anti-HCV can be achieved at the point of care (POC) with a whole blood antibody detection assay, HCV RNA (or core antigen) detection for the confirmation of active infection is typically deferred to central laboratories leading to lapses in the cascade of care. There is currently one molecular point-of-care platform approved by the FDA with the time to result of 60 minutes which may exceed the length of a clinical encounter. Consequently, the development of truly rapid, accurate, and user-friendly point-of-care tests would be advantageous to expand access to diagnosis and treatment. The DASH® Rapid PCR System is a sample-to-answer point-of-care platform combining state-of-the-art PCR kinetics with sequence specific hybridization with a result time of around 15 minutes. Herein we report the development of an HCV detection assay for the DASH® Rapid PCR System that has wide dynamic range, can detect HCV genotypes 1-6, and has a detection limit of 200 IU/mL with 100 μL specimen volume addition. In a preliminary study of 97 specimens, the DASH® HCV assay demonstrated 100.0% positive percent agreement (PPA) and 100% negative percent agreement (NPA) when compared to commercial platforms. The DASH® HCV test holds tremendous potential to enable same-day diagnosis and treatment in support of HCV elimination efforts.

Presenting authors: Jennifer L. Reed

Poster 24

Developing Small-Molecule Inhibitors to Investigate the Effect of CFIm Complex Disruption on Alternative Polyadenylation and HIV-1 Infection Permissivity

Human immunodeficiency virus (HIV) remains a serious global health challenge, with more than 40 million people currently living with HIV. Adherence to lifelong daily antiretroviral therapy (ART) is challenging for many people with HIV. The development of Lenacapavir, a first-in-class capsid inhibitor with a long-acting injectable form, represents a key advancement in HIV prevention and treatment. Lenacapavir targets a conserved site on the HIV capsid core that normally binds the host protein Cleavage and Polyadenylation Specificity Factor 6 (CPSF6). It is unclear whether disruption of CPSF6-capsid binding is part of Lenacapavir's mechanism-of-action. CPSF6 is a member of the cleavage factor complex, CFIm, which regulates polyadenylation site selection in mRNA 3' untranslated regions (UTRs). We previously found that knock out of CPSF6 in primary CD4+ T cells disrupts the regulatory role of CFIm, leading to changes in alternative polyadenylation (APA) and global shortening of 3' untranslated regions (UTRs). These changes cause broad transcriptional rewiring, which contributes to an increase in permissivity to HIV infection. Further, we found that the binding of HIV-1 capsid core to CPSF6 results in sufficient disruption of CFIm function to cause changes in APA and transcriptional rewiring. In our current work, we have developed a series of small molecules targeting the interaction between CPSF6 and its binding partner, CPSF5, in the CFIm complex. This work aims to identify a small molecule that successfully inhibits the function of the CFIm complex, which we hypothesize will recapitulate the APA changes and transcriptional rewiring observed in CPSF6 disruption by CRISPR knockout or HIV-1 capsid binding, and lead to increased HIV-1 infection permissivity in primary CD4+ T cells. Here, we screened a series of candidate CFIm inhibitors for increased expression of CXCR4 in primary CD4+ T cells. CXCR4 expression was selected for initial screening because our previous work demonstrated upregulation of this HIV-1 coreceptor in CPSF6 knock-out cells. CD4+ T cells were isolated from the blood of three healthy donors. Cells were treated with one of 12 different candidate compounds or DMSO only. Cells were subsequently co-stained for CXCR4 expression and viability, which were quantified by flow cytometry. Several of the compounds tested demonstrated increased CXCR4 expression compared to treatment with DMSO only. These compounds will undergo further testing for dose-response relationships and biochemical validation of CFIm complex disruption. Effective CFIm inhibitors will enable deeper investigation into the impact of CFIm complex perturbation on transcriptional rewiring and HIV-1 infection permissivity in primary CD4+ T cells.

Presenting authors: Julia Shanno

Poster 25

Basic and Advanced Workshops in Echocardiography for Pediatric Residents at Bugando Medical Centre in Mwanza, Tanzania

Background: Bugando Medical Centre (BMC) is a referral teaching institution with 200 pediatric beds, located in Mwanza, Tanzania, a region with a large burden of cardiac disease. Echocardiography capacity is limited with one pediatric cardiologist and no sonographers. Pediatric residents are the frontline cardiology providers and serve as sonographers, historically learning when clinically needed without formal training. The purpose of this study is to assess the efficacy of echocardiography workshops in improving comfort, knowledge, and skills in echocardiography among pediatric trainees at BMC. Methods: In September 2025, members from Lurie Children's Hospital of Chicago in collaboration with BMC facilitated basic and advanced echocardiography workshops for trainees based on their level of prior experience. In the two months prior to the workshops, lectures on cardiac anatomy, echocardiography protocol, and ultrasound physics were delivered asynchronously to BMC trainees. For five days, participants underwent a structured echocardiography workshop with didactics and hands-on practice with live models. The basic workshop focused on obtaining images of standard imaging planes (subcostal, parasternal long axis, parasternal short axis, apical, and suprasternal), while the advanced workshop focused on assessing ventricular and valvular function and identifying common cardiac pathologies. Participants were asked to complete comfort surveys, knowledge tests, skills assessments, and image interpretation tests pre- and post-workshop. Results: 26 physicians participated in the basic workshop, and 7 participated in the advanced workshop. Following the basic workshop, more participants reported being somewhat or very comfortable with understanding cardiac imaging and scanning planes (46% vs. 96%, n=24), and they demonstrated improved skill in image acquisition (mean 7.7 vs. 14.9 points out of 19, n=14), basic echocardiographic knowledge (mean 51% vs. 64%, n=24), and image interpretation (mean 62% vs. 76%, n=24). Advanced workshop participants also demonstrated improved skill in image acquisition (mean 13.0 vs. 15.7 points out of 19, n=6) and advanced echocardiographic knowledge (mean 51% vs. 71%, n=5). Conclusions: Following a structured, easily replicable echocardiography workshop, pediatric trainees demonstrated improvements in comfort, knowledge, acquisition, and interpretation of echocardiographic images. Next steps include evaluating longitudinal retention of echocardiography knowledge and skills.

Presenting author: Kathryn Lucas

Poster 26

Global health at home and abroad: How health access impacts political participation in rural communities in the US and Kenya

In 2025, rural communities around the world were affected by cuts to programs providing essential health infrastructure. In July, the One Big Beautiful Bill Act was signed into law, which includes nearly $1 trillion in Medicaid cuts. By 2034 healthcare access in the rural US will decrease, as an estimated 1.8 million individuals will lose Medicaid insurance and federal Medicaid spending on rural hospitals will decline by $50.4 billion. In February, USAID ceased operations that provided health and other development funding for low- and middle-income countries (LMICs). In the past two decades, USAID initiatives have saved 90 million lives. Unless USAID funding is re-instated, there will be an estimated 14 million preventable deaths by 2030. Rural communities in LMICs are losing health resources and impacted countries have limited options for alternative funding. Since rural health funding is undergoing a massive transition, it is imperative to understand the myriad ways healthcare access impacts these individuals. Our study uses historical observational data to estimate the impact of health access on political participation in rural communities. An emerging field of scholarship links health and political participation. In 2022, the AMA declared voting a social determinant of health, and their policy brief calls for safe and equitable access to voting. This connection between health and voting has been established in high-income countries with studies in the US, Canada, and Europe showing that individuals who self-report that they are physically healthy are more likely to vote than those who are not healthy. However, there is little scholarship focusing on this issue in rural areas, and to our knowledge no comparative studies exist highlighting the similarities between rural communities across the globe. This study asks: How does health access impact political participation in rural communities in Kenya and the US? While voting is a key metric, it is not the only form of political participation. Using original survey data from rural Migori County, Kenya and survey data from the Cooperative Election Survey and American National Election Study for US rural counties, our work investigates the association between health-seeking behavior and political attitudes towards leadership and involvement in various political activities such as attending community meetings, which is a key form of participation in rural areas. As cuts to health funding will disproportionately burden rural areas in both the US and Kenya, it is crucial to understand how this will shape not only the healthcare landscape, but also the political landscape. This observational study offers insights into the historical association between healthcare access and political engagement. In understanding prior patterns, we can anticipate potential future impacts.

Presenting author: Kelly Hunter

Poster 27

Improving HPV vaccinations in Ukraine

Background: Cervical cancer is the fourth most frequently diagnosed cancer among women globally and is the leading cause of cancer-related deaths among women living in low-and-middle-income countries. The primary cause of cervical cancer is infection with a few carcinogenic strains of Human Papilloma Virus (HPV). HPV vaccines have been extremely successful in cervical cancer prevention, administered routinely mostly in high income countries. Ukraine is a middle income country with robust system of gynecological services, high overall vaccine acceptance rates and HPV vaccine available. However, HPV vaccination rates in Ukraine remain low. The goal of this project is to understand barriers to HPV vaccination in Ukraine and development of strategies to mitigate them. Methods: We administered baseline surveys at the Prycarpathian Clinical Oncology Center (Ivano-Frankivsk, Ukraine) to parents/patients (n=34) and primary care physicians (n=40). We assessed knowledge, attitudes, practices, and perceived barriers, summarizing proportions with denominators and prioritizing key gaps. Results: In parents and teenagers, 23.5% were unaware of transmission routes, 29.4% were not aware of possibility of asymptomatic transmission or importance of vaccination in males (29.4%). However, they were generally aware of HPV and vaccine availability and showed high willingness to vaccinate even when paying out-of-pocket (97.1%). Physician surveys identified knowledge gaps in understanding vaccination in males (27.5%), age of eligibility (47.5%), dosing/schedule and route of administration (45%), risk groups, and appropriate follow-up (27.5%). Practice pattern questions showed that ~50% of physicians do not discuss HPV infection during encounters. Top perceived barriers were limited public awareness of HPV–cancer links (95%), cost (85%), and low awareness of vaccine availability (80%). Conclusions: Baseline surveys highlighted significant misconceptions and gap of knowledge in both patients/parents and providers. Results provide opportunity to bridge knowledge gap by educating primary care providers as a first step in improving rates of HPV vaccination in Ukraine Key words: HPV, vaccination, Papillomavirus vaccines, Cervical cancer prevention, vaccine acceptance.

Presenting author: Mariia Shipovskaia

Poster 28

Development of a Rapid Automated Point-of-Care Test for Mycobacterium tuberculosis Detection from Tongue Swabs and Sputum Specimens on the DASH® Rapid PCR System

Mycobacterium tuberculosis (MTB) infection is a major global health threat with more than 90% of tuberculosis (TB) cases occurring in low-and middle-income countries (LMIC) with limited healthcare infrastructure. Point-of-care (POC) testing compatible with LMIC environments is necessary to improve TB diagnosis and treatment and to stop transmission. The DASH® Rapid PCR System is a sample-to-answer POC platform combining state-of-the-art PCR kinetics with sequence specific hybridization with a result time of around 15 minutes. Here we report the development and preliminary characterization of an MTB detection assay that utilizes oral swab or sputum specimens (swab swirled in sputum) for the DASH® Rapid PCR System. Because MTB is resistant to conventional bacterial lysis techniques, we developed a portable sonication device to lyse the specimen before adding to the DASH® cartridge where automated DNA sample prep and dual target qPCR were performed to detect MTB insertion sequences IS6110 and IS1081. The analytical characteristics of the test including dynamic range, limit of detection, cross reactivity, microbial interference, and robustness against cross-contamination from specimen to specimen were evaluated. In a preliminary study of 100 (49 positive and 51 negative) de-identified blinded sputa, a test sensitivity of 96% and specificity of 88% was observed when compared to the culture, and in a test of 30 oral swab specimens (10 positive and 20 negative), the sensitivity was 70% and the specificity was 95%. The results are similar to target product profile threshold for POC indicating that further studies to evaluate test performance with fresh specimens are warranted.

Presenting author: Matthew A. Butzler

Poster 29

Family Income, Sex, and Adolescent Mental Health: Analysis of the UK Millennium Cohort Study

Socioeconomic inequality is a major determinant of pediatric health, with family income playing a central role in shaping mental health trajectories. Children from lower-income families face greater exposure to chronic stressors, instability, and limited resources, increasing risks of emotional and behavioral difficulties. While the income–mental health gradient has been documented across countries, less is known about its persistence into adolescence, a stage of heightened vulnerability to psychological problems. Moreover, few studies examine whether this gradient differs for adolescent males and females across multiple mental health domains. This study addresses these gaps by investigating associations between family income and adolescent mental health at age 14, using data from the UK Millennium Cohort Study (MCS). MCS is a nationally representative longitudinal study of over 18,000 children born between 2000 and 2002. Analyses focused on approximately 7,500 adolescents (3,780 males, 3,736 females) who participated in the age-14 survey. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), which captures total difficulties, along with conduct, hyperactivity, emotional, and peer problems. Family income, measured across multiple stages, was averaged into a measure of permanent family income (PFI). Adolescents were classified into five income quantiles. Multivariable regression models tested associations between PFI and SDQ outcomes, adjusting for demographic factors, maternal education, parental status, prenatal exposures, and child health. Analyses were stratified by sex to examine differences in strength and pattern of associations. Results revealed a robust inverse relationship between PFI and adolescent mental health difficulties. Higher income predicted lower total difficulties and fewer problems across all SDQ subscales. For males, PFI was most strongly linked to reductions in hyperactivity (coefficients: -0.74 vs. -0.58 for females) and conduct problems (-0.52 vs. -0.49). For females, stronger associations were observed for emotional (-0.67 vs. -0.56) and peer problems (-0.75 vs. -0.55). Although the overall gradient was evident for both sexes, these differences highlight sex-specific pathways in the manifestation of psychological symptoms. These findings extend previous work by showing that the income–mental health gradient persists at age 14, underscoring the continuing role of socioeconomic resources in shaping adolescent well-being. Importantly, results emphasize that poverty does not affect males and females uniformly. Rather, it interacts with developmental and socialization processes, amplifying different symptoms by sex. The study contributes to understanding social determinants of adolescent mental health and underscores the need for interventions that address both economic inequality and sex-specific vulnerabilities. Policies aimed at reducing income disparities, while tailoring supports to the distinct challenges faced by boys and girls, may be particularly effective in promoting mental health equity during adolescence.

Presenting author: Molly Heaney

Poster 30

Assessing malaria burden prior to vector control: A baseline study in a Nigerian secondary school cohort

Background: Malaria disproportionally affects Africa, with nearly one-third of deaths occurring in Nigeria. Methods to reduce morbidity and mortality associated with malaria can include chemoprophylaxis, vaccines, vector control, and post-infection treatment. Objectives: To examine baseline rates and burden of malaria illness prior to initiating a vector control quality improvement project in two under-resourced secondary schools in Kano State, Nigeria. Methods: Surveys were distributed to a cohort of 2401 students between two boarding schools. Students were asked about episodes of malaria in the past six months, relevant symptoms, and disruptions in learning continuity, along with basic demographic information. Insecticide-treated nets (ITNs) were provided to all 2,584 students and staff at the school. Additionally, mosquito screens were installed in all learning environments to provide protection in the classroom. Results: Of all surveys distributed, 1979 (82.4%) students returned a survey, with 794 (77.6%) and 1185 (86.0%) students responding from the boys' and girls' schools respectively. A total of 550 (69%) students at the boys' school and 737 (62%) students at the girls' school reported malaria at least once during the preceding 6 months, resulting in a combined incidence rate of 65%. Of those reporting malaria, the median number of school days lost was 3, with 508 (39%) reporting missing at least one week of school. The most common symptoms included headache (94%), loss of appetite (77%), and body pain (68%). Conclusions: Malaria contributes not only to physical illness, but also school absenteeism. Boarding schools offer a unique opportunity for preventative measures such as ITNs. Through the initiation of vector control quality improvement with ITNs and screens, we anticipate that future data will reveal a reduction in malaria incidence and school days missed.

Presenting author: Nayana Kundu

Poster 31

Too Late to Treat? Drivers of Cancer Care Delays in Nigeria: Insights from the COST-FIN Trial

Objectives: In low and middle income countries (LMICs), delays in cancer diagnosis and treatment are common and contribute to late-stage presentation and poor outcomes. COST-FIN is a randomized controlled trial in an LMIC investigating the impact of a financial navigation program (FNP) on financial distress in cancer patients. This analysis assesses the baseline prevalence and risk factors associated with delayed cancer diagnosis and treatment in COST-FIN patients. Methods: Adults diagnosed within six weeks with breast, colon, rectal, or prostate cancer at two Nigerian centers were eligible for COST-FIN. Participants were randomized 1:1 to FNP or control group. Baseline surveys captured timelines of symptom onset, diagnosis, and treatment; self-reported delays; and reasons for delays. Descriptive statistics summarized frequency and causes of delays; comparisons between study arms were conducted. Results: Among enrolled patients, 131 completed surveys on diagnostic and treatment delays. Median time from symptom onset to diagnosis was 26 weeks (range 0–339), and from diagnosis to treatment was 3 weeks (range 0–27). 58% (n=76) reported a diagnostic delay, most commonly due to lack of cancer awareness (72%), long wait times (18%), and diagnostic costs (15%). Delays in seeking treatment were reported by 24% (n=31), primarily due to treatment costs (74%) and traditional medicine preference (16%). No significant differences were observed between study arms at baseline (p > 0.05). Conclusions: Delays in cancer diagnosis and treatment are prevalent among patients in the COST-FIN trial. Cost and lack of cancer awareness are key drivers of delays. FNP through COST-FIN may lessen the financial burden of cancer care in Nigeria, reducing diagnosis and treatment delays and improving long-term treatment adherence. Public health strategies to boost cancer awareness and early symptom recognition are also essential to reduce care delays.

Presenting author: Nikhil Sriram

Poster 32

Voices at the Frontlines: A Qualitative Study within the Africa Infrastructure Relief and Support Initiative in Liberia

Introduction: In Sub-Saharan Africa, nearly half of healthcare facilities lack reliable oxygen access, limiting the ability to provide safe and effective care. Energy shortages and inadequate oxygen supply contribute to poor patient outcomes in many low-resource settings. While solar energy and oxygen systems have been introduced with reported benefits such as better clinical outcomes and improved staff performance, challenges like device shortages, battery reliability, and caregiver stress remain. This study focuses on the perspectives of frontline healthcare workers in Liberia, aiming to capture their experiences and identify practical barriers and facilitators that can guide sustainable healthcare delivery improvements. Methods: This study used a qualitative design to capture the perspectives of healthcare workers on solar energy and oxygen implementation in Liberia. Semi-structured interviews were conducted with nurses, physicians, and other medical staff at participating facilities using snowball sampling until saturation was reached. Interviews were recorded, transcribed, and analyzed thematically. Results: The study identified different themes reflecting various challenges and impacts related to oxygen therapy at FJ Grant Hospital. The Current Oxygen Delivery Devices theme highlights issues with the availability and functionality of oxygen cylinders, concentrators, and operating tanks. Operational and Resource Challenges cover difficulties such as power outages, resource deficiencies, and oxygen transportation issues that affect oxygen therapy delivery. The Preparedness and Response theme emphasizes the readiness of staff and hospital systems to handle emergency and critical conditions. The Employees and Patient Perception on the New Project theme encompasses the project's significance, the excitement it generated, and the reallocation of resources. The Operational and Emotional Impact theme deals with the stress experienced by hospital staff and families related to fuel supply and the emotional toll of healthcare challenges. Lastly, the Healthcare Impact and Patient Outcomes theme examines the effects of inadequate oxygen and electricity on patient mortality and morbidity, addressing how these shortages impact overall patient health. Conclusion: These findings reaffirm well-documented infrastructural barriers but also bring forward the underexplored emotional burden on healthcare workers, who described the distress of witnessing preventable deaths. Such strain threatens morale and retention, underscoring the need for solutions that address both the technical and human dimensions of care. The strong optimism surrounding the solar-powered oxygen project highlights its potential to transform service delivery by ensuring continuity of care and freeing funds for medicines and staffing. However, gaps in preparedness and training caution that infrastructure alone is insufficient; capacity-building and standardized education are equally vital. These insights suggest that policy responses should combine investment in sustainable solar-powered systems with strategies to support and train healthcare workers, ensuring that technological gains translate into resilient, equitable improvements in patient care.

Presenting author: Nivedita Kumar

Poster 33

Feasibility and Tolerability of Performing Portable MRI for Neurological Disorders in an Outpatient Neurology Clinic: A Prospective Cohort

Background: Magnetic resonance imaging (MRI) is crucial for diagnosing and treating neurological disorders. It provides key information to evaluate structural abnormalities, monitor disease progression, and identify complications such as stroke, demyelination, or neurodegeneration. Yet, access to MRI remains inequitable globally, particularly in low- and middle-income countries (LMICs), where cost, space, workforce, and infrastructure limit availability. Even in high-resource settings, barriers such as transportation, delays in scheduling, and patient discomfort reduce use, disproportionately affecting patients with preexisting disabilities or socioeconomic barriers to healthcare. The point-of-care, portable brain MRI (pMRI) aims to address these challenges. pMRI can acquire T1-weighted (T1W), T2W, fluid-attenuated inversion recovery (FLAIR), and proton density sequences, with recent studies demonstrating that the images are accurate and concordant with standard-of-care measurements. As well, it is designed to integrate efficiently into clinical workflows, requires minimal infrastructure, and has a lower cost. This study evaluated the feasibility, tolerability, and patient acceptability of pMRI among adults with chronic neurological conditions in an outpatient neurology clinic, with implications for adoption in LMIC settings. Methods: We conducted a prospective, mixed-methods cohort study at Massachusetts General Hospital in Boston (01/2021-08/2025). Adults with mild cognitive impairment or dementia of the Alzheimer type, multiple sclerosis (MS), Parkinson disease (PD), or stroke, were eligible if they had undergone or were scheduled for a standard MRI within 120 days. Participants completed pre- and post-imaging surveys on barriers to care and scan experiences and underwent a point-of-care, low-field portable MRI (pMRI) using the Hyperfine Swoop‚Ñ¢ system. Results: Among the 130 participants (53% male, 46% female), the mean age was 60.6 years (standard deviation (SD)=17.5). Diagnoses included MS (36%), dementia (22%), stroke (21%), and PD (20%). 71% reported at least one barrier to MRI care, with transportation, scheduling, cost, and distance cited most frequently. Despite these challenges, participants rated pMRI as highly tolerable, with 93% reporting comfort scores ‚â•7 (on a 10-point scale), and 78% indicating willingness to undergo future pMRI. Mean comfort ratings were significantly higher for pMRI (8.4) compared to traditional MRI (7.5; p< 0.05). Images were consistently readable and considered clinically useful. Qualitative feedback emphasized the need for improved physical accommodations but broadly supported the pMRI's acceptability and potential utility. Conclusion: These findings support the feasibility, tolerability, and high patient acceptability of pMRI as they require less cost, infrastructure, and staff. This positions the scanner as a promising tool in the structural barriers with diagnostic testing and treatment for neurological disorders, especially in LMICs. Our findings support further implementation research in diverse global settings where pMRI could be potentially integrated in community hospitals, outreach programs, and outpatient clinics, extending access to neuroimaging across resource-limited contexts worldwide.

Presenting author: Nomin Enkhtsetseg

Poster 34

Short-term Stroke Outcomes in a Developing Country: Early results from a low-resource stroke unit study

Background and Aims: Stroke remains a major global health challenge, particularly in low- and middle-income countries (LMICs), where resources are limited and data on early outcomes are scarce. Low-resource stroke units (LRSUs), adapted to local contexts, have been proposed to reduce stroke-related mortality and disability. This preliminary report presents one-month outcomes from the usual care phase of a pilot study in Kano, Nigeria, highlighting early case-fatality and disability rates and associated clinical predictors. Methods: A prospective observational study was conducted at a tertiary teaching hospital between October 2024 and February 2025. Consecutive patients diagnosed with stroke via clinical and/or imaging criteria were enrolled. Data collected included demographics, stroke type, comorbidities, stroke severity (NIHSS), functional status (mRS), and in-hospital interventions. Primary outcomes were 1-month mortality and disability levels. Results: Of 203 patients (mean age: 61 years; 54% male), 73% had ischemic stroke. Hypertension (81.3%), diabetes (23.6%),and atrial fibrillation (7.4%) were common comorbidities. Median hospital stay was 8 days (IQR = 8). The one-month case fatality rate was 30% (n=61), with 82% of deaths occurring in-hospital. Among 142 survivors, 65% had moderate-to-severe disability (mRS 3–5). Overall, 75.4% of all patients experienced death or significant disability atone month. Conclusions: One-month outcomes following stroke in this low-resource setting revealed high mortality and disability rates. These findings emphasize the need for improved early intervention strategies and scalable models of acute stroke care in LMICs.

Presenting author: Philip B. Gorelick

Poster 35

Clinical Characteristics and Presentation of Enrollees in COST-FIN: Nigeria's First Randomized Controlled Trial on Financial Navigation Plans for Oncologic Care

Background and Aims: Stroke remains a major global health challenge, particularly in low- and middle-income countries (LMICs), where resources are limited and data on early outcomes are scarce. Low-resource stroke units (LRSUs), adapted to local contexts, have been proposed to reduce stroke-related mortality and disability. This preliminary report presents one-month outcomes from the usual care phase of a pilot study in Kano, Nigeria, highlighting early case-fatality and disability rates and associated clinical predictors. Methods: A prospective observational study was conducted at a tertiary teaching hospital between October 2024 and February 2025. Consecutive patients diagnosed with stroke via clinical and/or imaging criteria were enrolled. Data collected included demographics, stroke type, comorbidities, stroke severity (NIHSS), functional status (mRS), and in-hospital interventions. Primary outcomes were 1-month mortality and disability levels. Results: Of 203 patients (mean age: 61 years; 54% male), 73% had ischemic stroke. Hypertension (81.3%), diabetes (23.6%),and atrial fibrillation (7.4%) were common comorbidities. Median hospital stay was 8 days (IQR = 8). The one-month case fatality rate was 30% (n=61), with 82% of deaths occurring in-hospital. Among 142 survivors, 65% had moderate-to-severe disability (mRS 3–5). Overall, 75.4% of all patients experienced death or significant disability atone month. Conclusions: One-month outcomes following stroke in this low-resource setting revealed high mortality and disability rates. These findings emphasize the need for improved early intervention strategies and scalable models of acute stroke care in LMICs.

Presenting author: Rahul Burra

Poster 36

Neurological Manifestations of Long COVID differ in the U.S, Colombia, Nigeria, and India: the role of socio-cultural factors

Objective: To compare the neurologic manifestations of post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) in patients from the United States, Colombia, Nigeria, and India. Methods: In this retrospective, multi-site study, we evaluated 3,157 adults, including 652 post-hospitalization Neuro-PASC (PNP) and 2,505 non-hospitalized Neuro-PASC (NNP) patients who reported neurological symptoms ‚â•3 months after SARS-CoV-2 infection in the U.S (249 PNP, 1,944 NNP), Colombia (50 PNP, 53 NNP), Nigeria (23 PNP, 83 NNP), and India (330 PNP, 425 NNP). Results: The mean age of PNP patients was highest in the U.S. (57 years), followed by Colombia (50.8), Nigeria (49.2), and India (41.1) (p< 0.0001). Among NNP patients, the mean age was 48.2 in the U.S., 37.6 in Colombia, 41.2 in Nigeria, and 39.3 in India (p< 0.0001). Overall, PNP cohorts were predominantly male (52.5%), while NNP cohorts were predominantly female (62.5%), with significant geographic variation. On average, PNP patients were evaluated 24.6 months after symptom onset, ranging from 15.6 months in the U.S. to 31.2 months in India. NNP patients were evaluated 19.3 months after symptom onset, ranging from 17.6 months in the U.S. to 27 months in India. The median number of neurological symptoms was greater in the U.S. (5 for PNP and NNP) and Colombia (4.5 for PNP and 4 for NNP) and lower in Nigeria (2 for PNP and NNP) and India (1 for PNP and NNP) (p< 0.0001). There were significant differences for most neurologic and non-neurologic symptoms across countries. In particular, brain fog was the most frequently reported symptom in the U.S. (88.8% PNP, 86% NNP), Colombia (62% PNP, 73.6% NNP), and Nigeria (47.8% PNP, 62.7% NNP), with lower rates in India (17% PNP, 11.5% NNP), where myalgia was the most frequently reported symptoms (31.2% PNP, 23.1% NNP). In addition, depression and anxiety were frequent in the U.S. (69.5% PNP, 73.7% NNP) and Colombia (74% PNP, 69.8% NNP), but less common in Nigeria (8.7% PNP, 6% NNP) and India (17% PNP, 17% NNP) (p< 0.0001). Multiple correspondence analysis of the most frequent symptoms showed a grouping of patients from the US and Colombia, which harbored a higher symptom burden than the grouping of patients from Nigeria and India. Among PNP participants, abnormal cognition was more common in the U.S. (34.6%) and Colombia (24%) and lower in Nigeria (18.8%) and India (5.5%) (p< 0.0001). A similar pattern was observed in NNP participants, with higher rates in the U.S. (23%) and Colombia (26.4%) compared to Nigeria (16.3%) and India (5.8%) (p < 0.0001). Conclusion: Neuro-PASC patients from high and high-middle-income countries (U.S. and Colombia) suffer from a higher symptom burden compared to patients from low-middle-income countries (Nigeria and India). This suggests potential contributions of socio-cultural factors, including the reluctance to disclose cognitive and mental health issues in Nigeria and India. This may also be associated with the relative importance allocated to those symptoms compared to the daily difficulties inherent to living in a resource-limited setting. These findings highlight the need for culturally adapted screening and care of Neuro-PASC worldwide

Presenting author: Rebecca Jules

Poster 37

Leveraging Machine Learning to Map Neoantigen Hotspots and Guide Immunotherapy Across Cancers

Neoantigens, arising from tumor-specific mutations, represent a promising avenue for precision immunotherapy by driving T-cell-mediated anti-tumor responses. Despite their potential, accurate identification of immunogenic neoantigens remains challenging due to high false-positive rates, tumor microenvironment complexity, and individual immune variability. To address these barriers, we enhanced ScanNeo2, a comprehensive workflow integrating genomic and transcriptomic data, with a machine learning–based predictor that improves neoantigen detection reliability and reduces false positives. We performed a large-scale, pan-cancer analysis across multiple cohorts spanning diverse cancer types and immunotherapy response profiles. Our study revealed shared neoantigen hotspots across tumor types, as well as population-specific mutation signatures that influence checkpoint blockade outcomes. This pan-cancer atlas reveals key determinants of immunotherapy response and supports strategies for patient stratification in diverse populations. Our findings underscore the global relevance of neoantigen-focused approaches to improving cancer immunotherapy outcomes.

Presenting author: Richard A. Schaefer

Poster 38

The Creation and Implementation of a Health Equity Course in the Swiss School of Public Health

Switzerland is one of the wealthiest European nations with a centralized health system. Yet, it is not without health inequalities including economic disparities, inaccessible care, and discrimination against marginalized communities. While the Swiss Academy of Medical Sciences recommends workforce development and training as part of transforming healthcare systems, the current model lacks training specific to health equity (HE). The Swiss School of Public Health (SSPH+) is Switzerland’s national coordinating body for postgraduate public health education and research, bringing together public health sciences from 14 Swiss universities into one cohesive inter-university program. We aim to examine the impact of integrating a course focused on HE research design and clinical practice in the SSPH+ across 4 cohorts to evaluate the impact on early-career healthcare clinicians and researchers. Evaluations will focus on understanding students’ knowledge and application of HE principles into their research and clinical practice. The Advancing HE in the Swiss Learning Health System course was co-created in 2024 using a modified Delphi method. The course was implemented in-person at the University of Lucerne in the fall of 2024 and 2025 and will be implemented annually to establish 4 cohorts. Early-career healthcare clinicians and researchers who take the course will complete: 1) a pre- and post-course HE knowledge assessment, 2) 6-month and 1-year post-course assessments of their application of HE concepts into standard practice, and 3) post-course interviews focused on their experiences during and after the HE course, along with their knowledge and application of HE principles. Statistical analysis will be used to understand patterns in participant survey responses. Thematic analysis will be used to assess changes in participants’ HE knowledge, research and clinical conduct, decision making, and community interaction following the course. Social network analysis will highlight communication and collaboration across specialties, and sustained connections beyond the course. Results to date include pre-, and post-, assessments from the 2024 and 2025 cohort, and 6- month assessments from the 2024 cohort. The 2024 cohort included 12 students; the 2025 cohort included 11 students. The research team are in the early stages of the interview process for both cohorts. Pre-course surveys for both cohorts indicated that participants had little experience with HE. In the 2024 cohort, 75% (N=9) had never taken a HE course and 75% (N=9) had never been on a team that submitted a HE focused manuscript. Post-course assessments from the 2024 cohort indicate an increase in HE skills confidence immediately following course. Much of these gains were maintained at 6 months with some small regressions. Participants indicated that early partner involvement and collaborative support were facilitators for their application of HE principles, while organizational priorities and process acted as barriers. Observing measurable shifts in HE understanding, awareness, and promotion among healthcare professionals will allow us to determine the effectiveness of the course. Our team will present findings at the European Public Health Conference and the Geneva Health Forum to highlight the advantages of integrating HE education in public health programs, to aid in the promotion of HE across the globe.

Presenting author: Ruth Debono

Poster 39

Pregnancy outcomes and HIV amongst women in Northwest Tanzania, from 2015-2016

Background: Adverse pregnancy outcomes are rampant across Sub-Saharan Africa and significantly increase the risk of neonatal deaths. In this region, HIV infection is a key contributor to adverse pregnancy outcomes and is disproportionately prevalent in women. Socio-demographic factors and care-seeking behaviors contribute to the contraction of HIV, as well as adverse pregnancy outcomes. Objectives: This study aims to determine the prevalence of HIV in Tanzania by age, residence, marital status, and education and to determine how pregnancy outcomes are impacted by HIV infection, the use of health services, and socio-demographic factors. Methods: This study utilized secondary data from an epidemiological Sero Survey Round 8 (2015-2016) within the Kisesa HIV cohort in Magu District, Mwanza, Tanzania. All data was analyzed using Stata Version 17.0. The variables were re-coded for operational use and cross-tabulations with chi-squared tests and logistic regression models were conducted. Results: The HIV prevalence was 9.5% amongst women who had one or more previous pregnancies. HIV positive women were more likely to lose a child (AOR=1.4; 95% CI: 1.1,1.7). Women with higher education had significantly lower odds of adverse pregnancy outcomes compared to women with no formal education, regardless of HIV status (AOR=0.5; 95% CI: 0.4, 0.7). Women with more children, especially 10+ children, also had higher odds of adverse outcomes compared to mothers with 1-3 children, independent of HIV status (AOR=25.1; 95% CI: 17.0, 37.0), and elderly mothers had seven times the odds of losing a child as compared to young mothers (AOR=7.0; 95% CI: 2.5, 19.6). Conclusions: This study provides insight into factors that contribute to HIV infection and adverse pregnancy outcomes. The results support the implementation of new policies that target HIV prevention and treatment amongst women and emphasize maternal education to reduce adverse pregnancy outcomes.

Presenting author: Samika Hariharan

Poster 40

Combatting Maternal Mortality in Rural India: A Mobile Solution

The United Nations Sustainable Development Goals (SDGs) call for reducing the global maternal mortality rate (MMR) to fewer than 70 per 100,000 live births, with no country exceeding 140. India, however, remains off track: approximately 71% of its districts report MMRs above 140. Existing government interventions, such as cash benefit programs that incentivize institutional births, have improved access but fail to address critical geographic barriers in rural regions. This poster presents a theoretical model for a two-pronged mobile clinic approach designed to reduce maternal mortality in underserved areas of rural India. The first component, a prevention arm, would provide comprehensive prenatal care and health education. Community health workers, trained and supported via telehealth by obstetricians, would deliver family planning counseling, conduct prenatal screenings (e.g., ultrasound, bloodwork for gestational diabetes), and teach recognition of pregnancy-related complications. This design prioritizes sustainability and cultural competence by leveraging local health workers. The second component, an intervention arm, adapts concepts from mobile emergency care models, such as Northwestern Medicine's stroke van. Equipped for obstetric emergencies, this mobile unit would contain supplies to manage hemorrhage, hypertensive crises, sepsis, and obstructed labor, including the capacity for crash cesarean delivery in resource-limited settings. Future steps include collecting qualitative data through nationally representative surveys to assess barriers to prenatal care, attitudes toward family planning, and current emergency resources in rural health centers. This theoretical framework demonstrates the potential of mobile clinics to address systemic gaps in maternal health and accelerate progress toward the SDGs.

Presenting author: Sanjana Shankar

Poster 41

Fluidic Diodes for Smart Paper Diagnostics: Transforming Lateral Flow into Programmable Global Health Testing

Since their introduction in the 1980s, lateral flow assays (LFAs) have become indispensable for global health, yet their basic design has changed little. Conventional LFAs are limited to simple, one-step binding assays, which restrict sensitivity, limit achievable detection thresholds, and prevent the integration of more complex multistep workflows. Our work introduces a new generation of LFAs that embed modular, programmable fluidic components. These include electro-gated valves, pressure-sensitive valves, and fluidic diodes. These elements enforce unidirectional flow and enable time-sequenced reagent delivery, effectively transforming passive, capillary-driven assays into "smart paper devices" capable of executing multistep diagnostic workflows. As a proof of concept, we developed a two-step LFA in which an initial analyte capture at the test line is followed by the delivery of a secondary detection probe in a subsequent step on the same device. This format decouples sample flow from conjugate flow, providing additional control over assay staging. Such designs are particularly advantageous for serological (antibody) assays, to enhance specificity. The 2-step workflow enables selective capture of the target antibody first at the test line (among interfering antibodies), followed by introduction of detection probes that typically are designed to bind the constant regions of the antibody. By expanding the functional design space of LFAs, fluidic-diode–enabled architectures create opportunities for customizable, field-deployable diagnostics. This flexibility is especially critical in global health, where low-cost platforms are needed to address diverse diagnostic challenges in resource-limited settings.

Presenting author: Selina Cervantes

Poster 42

CPAP Implementation Strategies for Optimized Neonatal Care: A Scoping Review

Objective: This scoping review aims to identify change ideas and implementation strategies that support CPAP use for eligible newborns (< 2500g, preterm, or with RDS symptoms), and to inform quality improvement efforts in NEST360-supported facilities in sub-Saharan Africa through relevant process measures. Introduction: Continuous Positive Airway Pressure (CPAP) is a well-established and effective treatment for neonates with respiratory distress syndrome (RDS), widely used to prevent respiratory failure in small and sick infants across different settings. Yet, its timely and appropriate use remains inconsistent due to persisting obstacles to access and implementation, particularly in sub-Saharan Africa. Gaps in CPAP coverage related to challenges in device availability, functionality, and delivery continue to hinder the provision of optimal care to vulnerable newborns. While the barriers have been widely documented, few literature reviews have systematically explored tangible strategies aimed at overcoming these barriers. Inclusion criteria: This review includes articles involving preterm and term neonates (< 28 days) with birth weight < 2500g and/or symptoms of respiratory distress syndrome (RDS), thus eligible for CPAP therapy. It focuses on interventions that support timely initiation and appropriate use of CPAP, including implementation strategies and change ideas for quality improvement. Eligible clinical settings include neonatal intensive care units, hospital wards, delivery rooms, and other newborn-focused environments. No geographical restrictions were applied. Studies will be excluded if they (a) do not center the defined neonatal population, (b) exclusively assess CPAP effectiveness rather than implementation, (c) explore CPAP use for unrelated conditions (e.g., sleep apnea), or (d) described barriers without corresponding solutions. Methods: This scoping review follows the Joanna Briggs Institute methodology and uses the Population–Concept–Context framework to guide inclusion criteria. This protocol is published a priori in alignment with PROSPERO guidelines. Searches were conducted in MEDLINE (via PubMed), Embase (via Elsevier), and CINAHL (via EBSCOhost) in August 2025, with no date limits and English-language restriction. The search strategy was peer-reviewed using the PRESS 2015 guideline. Reference lists of included studies will be screened for additional sources. Article selection will be performed independently by two reviewers using Rayyan, with discrepancies resolved by consensus or a third reviewer. Full-text screening will apply predefined inclusion criteria, and reasons for exclusion will be documented. Data extraction will be conducted using a piloted form developed by the review team, capturing facility and participant characteristics, implementation strategies/change ideas, context, and CPAP-related use outcomes. No critical appraisal will be performed, consistent with JBI guidance on scoping reviews. Results will be presented narratively and in tabular format, with a PRISMA-ScR flow diagram summarizing the selection process. Keywords: Neonates; continuous positive airway pressure; CPAP; Implementation; Quality improvement; change ideas; strategies; small and sick newborn care.

Presenting author: Serena Musungu

Poster 43

Strengthening Integrated Healthcare for Immigrant Women in Quito, Ecuador: A Quality Improvement Initiative

Authors: Tanya Bhargava BA, Susana Alvear, MD Partner Organization: Centro de Medicina Familiar La Y Background: In recent years, migrant health has become a significant consideration of public health, given the steady rise in migration. Ecuador, specifically, has seen a drastic increase in immigration due to conflicts in surrounding countries and their relatively lenient immigration rules. A majority of the population that migrates to Ecuador are women and children from Colombia and Venezuela who tend to require healthcare once arriving in Ecuador. For my APEx project as an MD/MPH student, I spent four weeks working with a community family medicine practice in Quito on a quality improvement project. The goal was to improve the quality and connection to care for immigrant women with healthcare needs in Quito, Ecuador. Methods: This quality improvement initiative was comprised of a data-gathering phase and an intervention design phase. Semi-structured interviews were conducted with patients and doctors at the family medicine clinic to understand the challenges immigrant women face when trying to access healthcare in Quito. The information collected was synthesized into a logic model to outline areas that could be targeted for improvement. Once these targets were identified, interventions were designed in collaboration with the clinic's doctors to address the problems. The remainder of the project period focused on supporting the implementation of specific interventions at the clinic. Results/Deliverables: Initial interviews identified five main targets for improvement at the family medicine clinic: 1. Upgrade building facilities 2. Improve Clinic Financial Sustainability 3. Enhance clinic publicity 4. Address gaps in patient knowledge 5. Improve coordination with partner foundation Specific, achievable goals were developed under each target to guide the organization toward its mission of supporting more immigrant women patients. During the project period, some interventions were implemented to address gaps in patient knowledge and enhance clinic publicity. Deliverables for this project included: 1. Culturally relevant pre-diabetes fact sheets 2. Flyers promoting the clinic's services 3. Informational pamphlets on the definition and role of family medicine 4. A designated play space in the clinic for children while parents attend appointments Discussion/Conclusions: This project identified key barriers immigrant women face when accessing healthcare in Quito and implemented targeted, sustainable interventions to improve care delivery. The findings support ongoing quality improvement efforts and contribute to the clinic's broader mission of strengthening integrated healthcare for migrant women and children.

Presenting author: Tanya Anjali Bhargava

Poster 44

Baseline Economic Hardships and Financial Distress Among Cancer Patients in Nigeria: Results from the COST-FIN Trial

Introduction Low and middle income countries (LMICs), like Nigeria, are expected to account for 75% of new cancer cases and 65% of cancer deaths by 2030. This disproportionate cancer burden amplifies financial hardship The COST-FIN trial is a randomized controlled trial in Nigeria that assesses the impact of a financial navigation program (FNP) on newly diagnosed cancer patients. This study evaluates the association between economic hardships and financial distress in patients enrolled in the COST-FIN trial at baseline. Methods Baseline COST-FIN data was analyzed cross-sectionally. Adults within six weeks of diagnosis of breast, colorectal, or prostate cancer at two tertiary centers completed an 11-item economic-hardship checklist (12-month recall) and the 11-item FACIT-COST (score 0-44, higher=less distress). Two hardship metrics were derived: any hardship (yes/no) and hardship count (0-11). Welch t-tests compared FACIT-COST scores between patients with and without hardship; multivariable linear regression modeled FACIT-COST as a function of hardship count, adjusting for demographics, cancer type/stage, trial arm, and site. Results Of 148 randomized patients (median age 52 years; 64 % female; cancer distribution: breast 64%, prostate 20%, colorectal 16%) 62% reported at least one unmet expense, most commonly transport (33%), meals (31%), and medical consultation fees (30%), while inability to pay health-insurance premiums was rare (5%). Mean FACIT-COST was 14.0 ± 3.4. Patients with ≥1 hardship scored lower than those without (13.2 ± 3.0 vs 16.0 ± 3.2; Δ = -2.8, 95 % CI -3.9 to -1.7; p < 0.001). In the adjusted model, each additional hardship item corresponded to a 0.9-point decrement in FACIT-COST (β = -0.91, 95 % CI -1.18 to -0.64; p < 0.001), explaining 29% of the variance in financial distress (model R² = 0.32). Trial arm, cancer stage, and baseline treatment exposures were not associated with FACIT-COST at enrollment. Conclusion This study found a high prevalence of economic hardship among COST-FIN trial participants, with each additional hardship corresponding to increased financial distress at baseline. Addressing basic unmet needs through interventions like FNPs may be critical to alleviating financial toxicity and improving cancer care outcomes in LMICs.

Presenting author: Valentina Velasco

Poster 45

TITLE 46

Human Immunodeficiency virus (HIV) is a lentivirus that causes acquired immunodeficiency syndrome (AIDS). Despite the development of antiretroviral therapy (ART), which has transformed HIV into a manageable chronic condition, the global HIV epidemic remains a major public health issue. People living with HIV (PLWH) face ongoing challenges, as they have to adhere to lifelong ART while managing the risk of side effects and antiviral resistance. These limitations underscore the urgent need for novel strategies that offer the potential for a functional cure for HIV infection. In the five reported cases of HIV cure, heterologous transplantation of hematopoietic stem cells carrying the CCR5Δ32 allele into patients resulted in sustained viral suppression after cessation of antiretroviral therapy. However, the mutation has been linked to weakened immune responses to other viruses and is only found at less than 1% frequencies in Northern European populations, limiting the applicable transplant recipient pool. There are over 2600 other reported allelic variants of CCR5, though the vast majority of these are rare and have not been tested for their impact on HIV infection. Traditional approaches to link genetic variants to human phenotypes, such as genome-wide association studies (GWAS), have limitations in cohort sizes and are often underpowered to capture rare alleles. Given these limitations, alternate approaches are needed to rapidly screen and identify variants of CCR5 that confer specific phenotypic outcomes. We hypothesize that other genetic variants of CCR5 will confer protection against HIV-1 infection while also retaining normal CCR5 function. To test this hypothesis, we generated a library of single guide RNAs (sgRNAs) that span the endogenous CCR5 locus for either adenine (ABE8e(V106W) (ABE) and cytosine (evoCDA1-BE4max) (CBE)-directed base editing. For each screen, primary human CD4+ T cells were isolated from healthy donors and transduced with the sgRNA library lentivirus and either ABE or CBE lentivirus. We extracted genomic DNA from the edited cells and performed long-read sequencing on PCR-amplified DNA to assess allelic variant frequencies. We successfully mutagenized the endogenous CCR5 locus and observed an increase in alternate allele frequency after selection. This trend was consistent across three donors and reproducible for both base editors. This project will provide critical insights for the development of new HIV cure strategies, as well as a proof-of-concept for a new functional genomics platform for interrogating the role of genetic variation in human disease at single-nucleotide resolution.

Presenting author: Yujin Lee

Poster 46

Adjudicated Stroke Mortality in Kano, Northern Nigeria

Background and Aims: Worldwide, sub-Saharan Africa has some of the highest rates of stroke mortality. In Nigeria, stroke is a leading cause of hospital admission. 1-year and 3-year stroke mortality rates are estimated to be 40% and 80%, respectively (Akinyemi RO et al, 2021). We are carrying out a low-resource stroke unit project in Kano, Nigeria, at the Aminu Kano Teaching Hospital and report on stroke mortality in the usual care (UC) phase of the study. Methods: In a stepped-wedge study design, we compare the primary outcome of the composite of 30-day death and disability in consecutive atherosclerotic-type stroke admissions who receive UC versus low-resource stroke unit (LRSU) care. Each stroke death is adjudicated by a committee of stroke experts, and the cause of death is defined according to the Cardiovascular and Stroke Endpoint Definitions for Clinical Trials (Hicks K et al., 2018). Results: The UC phase of the study was completed March 1, 2025, 203 participants (target: 200 participants) were enrolled. Stroke mortality in the first 30 days was 30%. Of the first 54 of 61 committee adjudicated deaths, the attribution was: 83% due to stroke, 15% to heart disease, and 2% to other non-cardiovascular causes. Overall, ~75% of enrollees had ischemic stroke and ~25% had intracranial hemorrhage (ICH). Deaths attributable to intracranial hemorrhage (ICH) were about 2x more likely compared to ischemic stroke. Conclusions: 30-day deaths attributable to stroke are high in Kano but potentially preventable. We discuss in-hospital deaths, risks and proactive measures we are taking to reduce death and disability in this low-resource stroke setting.

Presenting author: Yvonne Curran

Poster 47

Understanding Gaps and Opportunities in Pediatric Palliative Care Across ECSWA

Pediatric palliative care (PPC) is an essential but underdeveloped area of healthcare for children with life-limiting and life-threatening illnesses. Although PPC has gained recognition and grown in high-income countries, access remains extremely limited across East, Central, South, and West Africa (ECSWA). In Nigeria, the most populous country in Africa, there are only 17 palliative care centers, and none dedicated to pediatric populations. The lack of formal PPC infrastructure, trained personnel, and policy support in ECSWA countries presents a major barrier to improving quality of life for children in need. This scoping review aims to (1) provide an overview of PPC policies, guidelines, and national recommendations across ECSWA ; (2) identify implementation strategies and models of care, mapped where applicable to core domains of pediatric palliative care; and (3) describe existing PPC programs and interventions. A comprehensive search conducted across six academic databases and multiple grey literature sources retrieved 4,649 records in the preliminary testing. Additional exclusion criteria such as focusing on pediatric populations (ages 0–17) and including PPC-specific interventions, strategies, or policies, will reduce the included study selection. Both peer-reviewed research and grey literature—such as national guidelines, training frameworks, and strategic plans, will be considered. Two independent reviewers will screen titles and abstracts using Rayyan, followed by full-text review and standardized data extraction. Data will be synthesized through summary tables, PPC domain mapping, and narrative synthesis. Given Nigeria's geographic and cultural proximity to several ECSWA countries, the insights gained will have regional relevance, offering adaptable frameworks for neighboring nations facing similar health system constraints. Strengthening PPC in Nigeria can thus serve as a catalyst for broader regional collaboration and pediatric palliative care capacity-building across ECSWA. Findings will guide hospital leaders, policymakers, and training institutions in designing more responsive, scalable, and context-specific PPC services.

Presenting author: Zoey Hall

Poster 48

Doula Care and How Maternal Age May Determine its Impacts on Reducing Maternal Morbidity Rates in the United States

Background: Maternal morbidity rates are a crisis in the United States, and high rates of potentially risky obstetric interventions may be partially to blame. Birth doulas are a suggested solution to mitigate obstetric interventions. Despite women of different maternal ages facing different risks during pregnancy, research is not yet conclusive on whether the benefits of doulas may vary for different age groups. Methods: A literature review was conducted through PubMed and CINAHL with the inclusion criteria that the article be published in English between 2000-2025, be about doula care and its impact on cesarean sections and/or forceps assisted deliveries, and include age as a measure demographic. Articles must be from a peer-reviewed journal. Findings: Insignificant literature was found regarding forceps assisted deliveries. Doulas likely reduce the risk of cesarean sections for adolescents (< 20 years old) by connecting adolescents with needed food and housing resources, accompanying adolescents to medical appointments they may have otherwise skipped for fear of stigma, and reducing maternal stress. Stronger evidence exists showing doulas reduce cesarean section rates for adults (20-34 years old) by screening for maternal mental health, assisting mothers in accessing needed resources, and providing culturally competent care. Insignificant literature was identified for pregnant people in the advanced age group (35+ years old). Conclusion: Existing literature has the strongest evidence that doulas reduce cesarean section rates for pregnant women in the adult age category. More research must be conducted to confirm the differences in degree of benefit between the age groups and concretely identify the benefits of doula care for women in the adolescent and advanced age categories.

Presenting author: Zora Warren

Poster 49