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)
Mixed-Methods Evaluation of Perspectives on Determinants ofSuccess in a Pilot Hybrid Type 2 Effectiveness Implementation TrialIntegrating Hypertension Control into HIV Care in Botswana
Background: Due to the success of HIV treatment in Botswana, people with HIV (PWH) have aged to develop chronic conditions, including cardiovascular disease and hypertension. However, uptake of evidence-based practices for these conditions is low.InterCARE is a package of implementation strategies that integrates hypertension treatment into HIV care in Botswana by:1)adaptation of the electronic health record (EHR) to include hypertension-related data and cardiovascular risk assessment, 2)provider training, and 3) use of treatment partners (peers who support PWH in attending appointments and taking medications).A pilot hybrid type 2 effectiveness implementation trial in two public HIV clinics found high effectiveness, adoption, and fidelity overall but low adoption of EHR components. This mixed-methods research aimed to explain these outcomes to inform future scale-up. Methods: Guided by the Consolidated Framework forImplementation Research, surveys and semi-structured interviews were completed with four groups (N = 100 surveys, 10 interviews): community members, healthcare workers, patients, and treatment partners. Data collection occurred in-person after 12-months ofInterCARE implementation. Descriptive statistics and Fischer's exact tests were calculated for surveys, and a deductive analysis was completed for interviews (Kappa=0.86). Findings: Overall, surveys showed positive perceptions of the strategies. Pre-post analyses revealed that post-implementation fewer community members strongly agreed that combining hypertension and HIV care into the same visit would be too complicated (p=0.03). Interviews discussed high acceptability ofInterCARE and its relative advantage over siloed care. Strategies improved patient experiences by increasing efficiency of care (e.g., reduced visit frequency, time, cost). Integration of care and use of treatment partners increased medication adherence. Barriers included insufficient resources, HIV stigma, high provider workload, and need for HIV providers' training in hypertension.Suggestions to improve implementation included education to increase client awareness and understanding of services, dissemination strategies (e.g., social media, community meetings, handouts), and efforts to increase buy-in, including clinic leadership and public health workers to serve as champions. Discussion: Findings informed adaptation of the implementation strategies before scaling up to a large-scale hybrid effectiveness-implementation trial throughout Botswana. This research provides valuable insight into factors that affect outcomes from bundled implementation strategies among chronic diseases and HIV in resource-limited settings, which can help advance global implementation science.
Presenting author: Amelia Van Pelt
Poster 1
The Failures of Global Health Imagery: The Continuation of Colonialism in Global Health
The term "Global Health" gained substantial momentum in the early 2000s amid a burgeoning social movement in Western nations advocating for universal access to quality healthcare as a fundamental human right. Despite the initiation of decolonization in the mid-1950s and the establishment of humanitarian organizations, the past colonial tendencies of the Western world continue to persist in global health under the guise of "development." The internalized subjugation of global south communities is subtly portrayed through global health imagery. An analysis of the promotional imagery utilized by the Bill and Melinda Gates Foundation and Partners In Health reveals the hypocrisy of such influential humanitarian organizations. The images reveal a shocking portrayal of communities of color, usually in a demeaning comparison to their Caucasian counterparts. Such images perpetuate a visual power imbalance between Western nations and global south communities, reinforcing the cultural and social domination that colonialism is defined by. Further visual emphasis is placed on the Western leader's "selfless" involvement in improving healthcare access and infrastructure in the global south, appealing to the Western world's white savior complex at the expense of communities of color. The iconicity of these global health leaders' "benevolence" inherently relies on indirect strategies to simultaneously conceal violence and signify power. In order to combat the continuation of colonialism in global health, cultural awareness must be integrated into global health imagery, preventing the perception of organizational health interventions from dehumanizing and reducing the lives of people of color. Alongside decolonization efforts, there must be an active endeavor to shift the focus and priority of global health interventions from Western interests to the lives of the people they aim to serve.
Presenting author: Aparnaa Ananthakrishnan
Poster 2
Using the Injury Equity Framework to identify and organize risk and protective factors for pediatric injury prevention and care in low- and middle- income countries
Background: 1 million yearly pediatric deaths in low- and middle-income countries (LMICs) are due to trauma. Numerous factors beyond location, mechanism, and event phase reported in the Haddon Matrix contribute to injury prevention, severity, and treatment. The Injury Equity Framework (IEF) was developed to systematically identify and address factors which contribute to inequities in injury outcomes. While it was built and has been applied to US studies, there is a need to adapt the framework using available global data. This study aims to identify factors related to unintentional pediatric injury in LMIC settings and organize them using the IEF, adding any needed LMIC-specific layers. Methods: The protocol and search strategy for this systematic review is registered in PROSPERO. At this time, title/abstract screening is in progress. Initial search of articles was conducted in July 2024 across seven databases, producing 4165 unique citations. Included articles were those published 2010 or beyond to reflect recent data. Included articles discussed child injury equity or child injury prevention in an LMIC setting. Injuries encompassed included drowning, road traffic, poisoning, foreign bodies, and safe sleep/sudden infant death. Articles are excluded if they focused on intentional injury, sequelae post-injury, or injury testing or treatment without information on pre-injury characteristics. Data extraction will focus on relevant components of the IEF. Findings: Results from initial title/abstract screening of one reviewer suggest 2284 (54.8%) of articles found to be relevant. Article types ranged from reporting of emergency or trauma registry data, to injury case reports, to interventions for caregivers on injury prevention. Road traffic related incidents, including on child restraint system usage and knowledge, as well as drowning reports were most frequent. Many facets of the IEF including legislation, treatment, environment, equipment, and education were discussed and will be presented. Interpretation: Numerous factors related to social context and equity are important for child injury prevention and care. Organizing them through the IEF by injury and setting may be a helpful tool for future studies to understand and anticipate areas of need.
Presenting author: Arthi Kozhumam
Poster 3
Ethical responsibilities and current practices for research on non-communicable disease in resource-limited settings: results from a narrative review
Limited guidance exists regarding the obligations of researchers conducting non-communicable disease (NCDs) research who identify people with treatment needs in settings with limited health system capacity. We conducted a narrative review to explore the current considerations around ethical principles, responsibilities, and recommendations for survey research in low-and-middle-income countries (LMICs). We searched Embase, Scopus, and PubMed and identified additional references by reviewing article biographies and input from experts in the field. Twenty-three articles and guidelines were identified, with broad agreement on the need for guidelines on researcher responsibilities relating to treatment access for study participants diagnosed with NCDs where health system capacity is limited. While authors argued that researchers have a moral obligation to communicate results to participants, there was considerable variability in recommendations and strategies around treatment access ranging from direct provision of care at supported health care facilities, supported referral to care, to recommendation to seek care. Consideration of broader health system strengthening also varied, ranging from recommendations to engage stakeholders through advocacy to direct support of facilities serving study areas. While the development of guidelines was widely supported, some scholars highlighted the need for an ethical framework that accounts for local normative standards of care when defining what ethical obligations to provide treatment access exist. Results of our narrative review will frame a convening of experts in ethics, NCD research and treatment, and policy makers to discuss next steps for development of recommendations for guidelines.
Presenting author: Arthi Kozhumam
Poster 4
Scoping Current Opportunities for Health Professions Education in Eastern, Southern, and Western Africa
Background: As the global demand for physicians and other health care professionals grows around the world, there is increasing emphasis on promoting high quality health sciences education on an institutional level. Departments of Health Professions Education (DHPEs) and Departments of Medical Education (DMEs) in low- and middle-income countries (LMICs) have been created in recent years for curriculum reform, faculty training, development of scholarship in teaching and learning, quality assurance, research, and academic support. This study aims to understand the structure and function of DHPEs in eastern, southern, and western Africa and develop recommendations for establishment and strengthening of DPHEs in similar contexts. Methods: In a collaboration between Northwestern University and AFREHealth, we developed and distributed a 33-item REDCap survey on various DHPE activities and actors identified in the literature via purposive sampling to anglophone schools identified via the World Directory of Medical Schools. Duplicate responses from institutions and responses not identifying a school were removed. In parallel, team members conducted semi-structured interviews with leaders of existing or in-development DHPEs, with a focus on staffing, logistics, and funding for the DHPE. Descriptive statistics and rapid summary analysis were conducted. Findings: 27 participating institutions were included in quantitative analysis representing nine countries. 14 had a dedicated health professions education (HPE) unit, with 92% having internal and 39% external funding. 32% of full-time and 25% of part-time faculty had medical degrees. Activities noted included capacity building, curriculum development, research in HPE, and faculty mentorship and advising. 25 interviews completed and analyzed to-date from eight countries indicate 68% of respondent institutions have a DHPE. DHPE creation was facilitated by senior leadership champions, faculty backing, and international partners. Need and impetus for DPHEs included accreditation, professional development, curriculum review, patient safety, and pedagogical teaching. Challenges include financial, infrastructure, and human resources including faculty expertise and responsibilities. Interpretation: DHPEs engage in a wide range of activities, all of which have the potential to strengthen HPE in the region. While several challenges for DHPE sustainability exist, particularly related to funding and faculty availability, the potential for DHPEs to enrich educational endeavors across the region cannot be discounted.
Presenting author: Arthi Kozhumam
Poster 5
Training and Capacity Building in Patient-Centered Outcomes Research for HIV Care in Tanzania
Background: Advances in human immunodeficiency virus (HIV) care and treatment have transformed diagnosis from a fatal to a manageable chronic condition. In Tanzania, an estimated 1.7 million people are living with HIV (PLHIV), of whom 79% have HIV viral suppression and improved survival. This success has increased the importance of Patient-Centered Outcomes Research (PCOR), a valuable tool for improving healthcare outcomes by targeting what is most important to PLHIV. Patient-Reported Outcomes Measures (PROMs) evaluate these outcomes, highlighting areas for improvement to achieve treatment effectiveness and people-centered care. However, their implementation is limited in Tanzania and other low- and middle-income countries (LMICs). Since 2019, Northwestern University and Muhimbilli University of Health and Allied Sciences (MUHAS) have led an NIH-funded Fogarty D43 grant designed to build PCOR capacity in Tanzania. As part of that scope, a workshop was designed to strengthen capacity in PROM psychometric validation and cultural adaptation in the MUHAS scientific community. Methods: The three-day, in-person workshop was designed to strengthen participants' skills in developing, selecting, adapting, and validating Patient-Reported Outcome Measures (PROMs) to improve health outcomes for PLHIV in Tanzania. The workshop included didactic instruction and practical exercises led by experts from both institutions. Topics included PROMS selection, development, adaptation, cultural adaptation, testing for validity, factor analysis, and manuscript writing. Participants completed a pre-workshop survey measuring their goals, experience, knowledge, and confidence in areas covered by the workshop. Questions included Likert score (0-3) and open-ended questions. They also responded to multiple-choice test questions on PROMS, factor analysis, validity, and cognitive interviewing. Immediately after the workshop, participants completed a post-evaluation survey to measure change in their knowledge and confidence and to obtain feedback on the workshop. Results: Twenty-seven participants (44.4% male) attended the workshop. There was a significant (p< .001) increase in knowledge and confidence ratings for all workshop topics (Figure 1). Reported knowledge ratings increased from a mean of 0.44 (SD = 0.68) to 2.55 (SD 0.56). Reported confidence also increased from a mean of 0.47 (SD = 0.72) to a mean of 2.55 (SD 0,56). The majority of the participants reported that the training was successful in meeting both the workshop goals (92%) and their personal goals (87.5%). Rates of correct answers assessing their knowledge of PROMS, factor analysis, validity, and cognitive interviewing also increased. In addition, qualitative information from open-ended feedback also suggested high enthusiasm for the course and increased confidence with intentions to implement the tools learned in the participants' current future research.
Presenting author: Berivan Ece
Poster 6
A Capacity Building Workshop for Microbial Genomic Surveillance in Peru
During the onset of the COVID-19 pandemic, Latin American countries were afflicted with an exorbitant number of fatalities accounting for more than 40% of the world's deaths. One key issue elucidated during the pandemic was the lack of surveillance and tracking systems needed to be in place to detect threats to public health. Limitations in genomic surveillance were associated with the high cost of equipment and consumables required to perform this essential task. Genomic surveillance systems tools are essential to track new COVID-19 variants by identifying mutations that gives the virus a survival advantage. Given the potential of a pandemic to disseminate rapidly across borders information about pathogen variants is crucial to implement public health policies and mitigation strategies. The goal this applied experience (APEX) project focused on sharing latest genomic tools that could bridge the gap for genomic surveillance of respiratory pathogens. In partnership with the Institute of Global Health (IGH) and el Centro de Investigaciones Tecnologicas, Biomedicas y Medioambientes (CITBM) and its affiliates in Lima Peru. We sought to 1) instruct students and staff on wet lab techniques required to sequence COVID-19 samples using Nanopore technology and 2) to deliver a bioinformatics workshop tailor to use Nanopore sequencing. Completion of these objectives will address some of the challenges and will provide more affordable alternatives to genomic surveillance.
Presenting author: Claudia E. Oropeza
Poster 7
Quantifying the Urologic Disease Burden in the Federated States of Micronesia (FSM)
Background: The Federated States of Micronesia (FSM) is a nation comprising 607 islands across 1 million square miles of the Pacific Ocean that is divided into 4 states (Pohnpei, Kosrae, Chuuk, Yap). The 2020 census population of the FSM was 103,169, with 6,047 of those people in the state of Kosrae. The FSM gained independence in 1986 but is still heavily reliant on US aid, which provides $110 million in annual aid through 2023 ($1.3 billion since 1986) and comprises a large percentage of the country's operating budget.1 There is scarce data regarding urologic diseases in the FSM and they face significant barriers to care that are unique to island communities, notably, infrastructural constraints, lack of medical training institutions, and geographic dispersion of patients. Objectives: To review the existing literature surrounding the urologic disease burden of the FSM and perform a survey of the urologic capacity on the island of Kosrae. Methods: For this review, we searched government databases, MEDLINE, EMBASE, CENTRAL Register, Cochrane Library, and Scopus for studies on urologic conditions in the FSM. The urologic capacity survey was a retrospective cohort study conducted in the Kosrae health system. Urologic conditions in this population were identified using ICD-10 codes followed by manual chart review. Patients with cause of death listed as "Unknown" or "Cancer Suspected" were reviewed by manual chart review to determine if their death was urologic in origin. After chart review, disease incidence was calculated via age-standardized incidence rates (ASIR). Findings: No published urologic studies exist in public databases. Our review found that the only existing FSM-specific data is for benign prostatic hyperplasia (BPH) and prostate cancer (PCa). FSM is amongst the highest increasing Estimated Annual Percent Change for age-standardized rates of years lived with disability with BPH of 204 countries/territories.3,4 For PCa, ASIR have risen from 8-14/100,000 men in 1990 to 14-23/100,000 men in 20165,6. In 3 of 4 states (Yap, Chuuk, Pohnpei), 5 cancers cause the majority of cancer-associated mortality, one of which is PCa.7 From our urologic capacity survey, the health system structure is 1 hospital per state with a few community health centers serving the villages. Urologic problems are managed conservatively by primary care physicians (PCP's) as there are no urologists in the FSM and they send patients in need of escalated care to Guam, Philippines, Hawaii, or the mainland US. Furthermore, Kosrae has a single portable x-ray and a single trans-abdominal ultrasound, with the only CT scanner on the capital island (Pohnpei). Urology-specific ICD-10 code data via chart review is pending. Conclusions: There is minimal data in the literature about urologic diseases in the FSM, with the only FSM-level data in BPH and PCa. There is a significant need for urologic care in the FSM as the only current urologic care available in Kosrae is conservative management by PCP's. Furthermore, the urologic capacity is limited by lack of diagnostic and therapeutic equipment. This warrants further study into interventions to provide sustainable urologic care to the island of Kosrae and the FSM.
Presenting author: Conor Driscoll
Poster 8
Molecular Epidemiology of SARS-COV-2 in Bolivia and Peru
Since its emergence in 2019, SARS-CoV-2 has reshaped the global health landscape, demonstrating the critical importance of rapid and accurate genomic surveillance for tracking viral evolution. As the virus mutates, the emergence of variants with enhanced transmissibility, drug resistance, immune escape potential, and increased viral fitness poses an ongoing threat to public health. Genomic surveillance plays a pivotal role in identifying these variants of concern, guiding public health interventions, and shaping vaccination strategies. However, most reported COVID cases and genomic surveillance data are largely provided by economically advantaged regions such as Europe, North America, and Asia. This disparity creates significant gaps in the global SARS-CoV-2 surveillance network, particularly in low- and middle-income countries (LMICs) like Peru, and Bolivia. In collaboration with the Universidad Nacional Mayor de San Marcos (UNMSM) in Peru and the Universidad Autonoma Gabriel Rene Moreno (UAGRM) in Bolivia, our study aims to address these challenges by expanding both laboratory and computational infrastructure for SARS-CoV-2 sequencing. From November 2022 to January 2023, 200 isolates were collected from Santa Cruz, Bolivia, and shipped to the Center of Pathogen Genomics and Microbial Evolution (CPGME) at Northwestern University. Of those isolates, 155 genomes were generated via a SARS-CoV-2 whole genome deep sequencing pipeline. When comparing circulating SARS-CoV-2 in South America in the same timeframe using phylogenetic analysis, we identified country-specific circulation in Bolivia distinct from its neighboring countries (Peru, Brazil, Argentina, etc.). Specifically, we identified lineages EF.1 and BQ.1.8, which previously circulated in low global frequency in Europe. Currently, ongoing efforts and sequencing in the area are being performed with over 600 isolates received and expanding our collection period from January 2023 to March 2024. Between July 2022 to March 2024, 270 isolates from Peru were sequenced and analyzed to investigate phylogenetic dynamics and circulating lineages. Our analysis indicated that there were at least two instances of increasing viral population size; the first occurred by the end of December 2022, and the second at the end of November 2023. The first expansion seems to be led by local circulating viral populations, given that the main lineages are rare worldwide and more prevalent in Peru and neighboring countries. The latter expansion was primarily driven by globally circulating JN.1 lineages. However, within this expansion, we observe the local expansion of a distinct lineage JN.1.42 that seems to be dominated in the Loreto Region. The Loreto Region in Peru in notably underdeveloped, which limits access to healthcare facilities and creates a bottleneck effect, where reduced surveillance and delayed detection favor the persistence and spread od distinct lineages, potentially allowing unique variants to emerge unnoticed. These findings highlight the importance of expanding local sequencing capabilities and enable more comprehensive and timely reporting of circulating viral lineages to LMIC's.
Presenting author: Dulce Garcia
Poster 9
Characterizing Hepatitis B in the African Hepatitis B/HIV-HBV Clinical Research Network
Introduction An estimated 65 million people are living with chronic Hepatitis B (CHB) in sub-Saharan Africa (SSA). HBV prevalence rates in Nigeria, and Mali are some of the highest in SSA, ranging from 5.2 – 9.5%. Among persons with HIV, HBV prevalence is approximately 5-10%. Characterization studies of HBV in SSA are currently lacking, particularly among persons with HIV. These are important to identify participants most in need of treatment and monitoring for liver disease progression. Methods This is a cross sectional analysis of baseline data collected from adult HBV and HIV-HBV co-infected participants enrolled in a large African multi-site observational cohort study of chronic Hepatitis B outcomes. Participants in this analysis were recruited from three academic institutions in West Africa [Jos University Teaching Hospital, Nigeria (JUTH), Lagos University Teaching Hospital, Nigeria, and University of Science of Technical and Technology De Bamako, Mali (USTTB)]. Eligible participants included those with: i) known HBV (defined as seropositive for HBsAg); ii) known HIV status (defined as HIV seropositive or seronegative); iii) >18 years of age and; iv) no history of decompensated liver disease, or hepatocellular cancer. Descriptive statistics were used to measure and compare socio-behavioral, demographic, and clinical data. Results A total of 296 participants were analyzed [HBV mono-infected (230,78%) HIV/HBV co-infected (66,22%)]. (Table 1.) 52% were female with a mean age of 41 (SD=13.08). 73% of HBV participants and 100% of HIV/HBV participants were receiving HBV active treatment alone (HBV) or as part of ART (HIV/HBV), respectively. Mean log HBV DNA copies/mL was 3.24 (SD=1.91). 6.75% were HBeAg seropositive. HIV/HBV vs. HBV participants were older, predominantly female and more likely to report MSM as a risk factor for HBV transmission. HBV participants were more likely to be anti-HCV positive and had higher ALT levels and transient elastography (TE) scores than participants with HIV/HBV co-infection. Conclusions In this study of West African persons with mostly HBeAg negative HBV infection, notable differences in disease characteristics were observed between those with and without HIV co-infection. The higher mean TE and ALT scores in HBV mono-infected suggest a need for close monitoring and surveillance for other liver complications. Work is ongoing to further assess the effects of treatment on liver disease activity in these individuals.
Presenting author: Edith Okeke
Poster 10
Evaluation of Research Administration needs at Makerere University
Background Uganda, a low- and middle-income country (LMIC), faces a high burden of disease, particularly communicable diseases, which accounts for over 50% of the morbidity and mortality in the country. Over the past ten years, Makerere University, the leading research-intensive institution of higher learning in the country, has become a leader on the African continent in research that is working to address some of the highest impact health problems. With the continued research growth, the Makerere Research Administrators (RA)s have not been able to keep up with this rapid growth in funding. To address this discrepancy, the University is committed to strengthening research administration infrastructure for staff through continuing education, as well as the establishment of standard operating procedures (SOPs) in order to ensure continued knowledge transfer and sustainability. Studies on career pathways for RAs are not well documented, however there are articles that include the importance of well-trained RAs to an organization's overall research environment. Well-developed research administrative support allows for institutions to ensure they are creating successful research environments for their faculty. RAs that understand the grant making process and procedures, are able to have fast turnaround when serving faculty members on their projects (Bradke, 2023). This allows for scientists to spend more time focusing on the science, and less time on the administrative burden of grants (Bradke, 2023 & White-Jones, 2023). The ability to be aware of policies and procedures, allows RAs to independently complete required compliance tasks and communicate with collaborators (White-Jones, 2023). Methods A team of Makerere University and Northwestern University administrators are leading the project to evaluation and develop SOPs for a Research Administration career pathway at Makerere University. To understand the capacity of Research Administrators and the needs of Faculty at Makerere, two surveys were developed to assess the pre-intervention. Survey questions for Research Administrators will be used to assess knowledge and skills of pre-award and post-award management of the administrative and financial aspects of the award. The survey for Faculty will assess their awareness and utilization of Research Administrators capacity, gauge baseline knowledge of grants, and identify any unmet needs in research administration to successfully manage their grants. These surveys will be used to develop on-site trainings for Research Administrators at Makerere. Results/Findings Surveys will be administered Fall 2024 and analyzed in Winter 2024.
Presenting author: Elizabeth Christian
Poster 11
Co-Creating Health Equity Training in the Swiss Learning Health System
Background: Globally, health systems are plagued by hard-to-define health problems such as rising healthcare costs, recent pandemics, and a growing digital divide. Thus, health systems are becoming a complex network of social interdependencies struggling to resolve health delivery issues and the many causes. Learning health systems (LHS) work to address these challenges by continuously aggregating and analyzing data from ongoing healthcare interactions to define best practices and embed these insights into the delivery process for improved care. LHS are aspirational models as they aim to increase ongoing dialogue among researchers, policymakers, practitioners, and patients for continuous healthcare improvement and innovation. By creating networks that link a broad range of health system partners, LHSs facilitate the dissemination of knowledge and enable the development and implementation of evidence-based solutions to a community's health problems. The healthcare system in Europe, designed to be universal, still faces significant gaps between evidence and policy responses to health inequities. In Switzerland, gaps are partially rooted in highly decentralized healthcare as its 26 cantons independently govern and promote healthcare. The Swiss LHS (SLHS) was established to provide a bridging mechanism for exchanges among healthcare partners to address current and emerging challenges in healthcare delivery in Switzerland. Its methodological approach involves identifying key challenges in the Swiss health system, engaging doctoral researchers to produce policy briefs that inform partner dialogues, and providing a platform to discuss and support implementation. Embedded within the SLHS, this project aims to better understand health inequities in Switzerland by incorporating health equity principles into the research training of doctoral researchers. Methods: We used the co-creation of the curriculum method and the ADDIE model for instructional design to collaboratively develop a health equity course for doctoral researchers within an LHS framework. Two modified Delphi rounds of surveys and virtual consensus workshops were conducted with co-creators, (e.g., academics, clinicians, social service providers, policy experts and patients) from Switzerland, to promote diversity and inclusivity. This project also facilitated the involvement of LHS health equity experts from the United States, enriching the development process of the SLHS training set to take place in November 2024. Results: A threshold of 75% agreement was deemed as "consensus" among 28 co-creators. Two live virtual sessions in late October will address health inequities at individual and system levels and explore participatory research methods. The in-person block sessions will focus on practical topics, such as measurement tools, analysis methods, and translating research into policy and practice. The course will highlight community narratives and lived experiences, culminating in a group design challenge and evaluation. Most co-creators (93%, N=14), who completed the co-creation process evaluation, agreed that the process enhanced the course's relevance to current community needs. Additionally, 80% (N=12) believe this collaborative approach will help learners produce more useful knowledge for informing policy and practice decisions. Conclusions: The course will extend the learning competencies within the SLHS to improve skills in health equity assessment, disparity identification, and LHS methods to measure and promote equity on a system level for individuals and populations.
Presenting author: Emily Lynott
Poster 12
Nanomechanical Systems for the rapid detection of HIV-1 p24 antigen
According to UNAIDS there were around 40 million people living with HIV globally in 2023. Despite the ongoing HIV epidemic, the increase in knowledge surrounding the virus, and the availability of antiretroviral therapy for HIV suppression, an estimated 5.4 million people living with HIV globally were unaware of their status. Diagnosis, specifically early diagnosis, is necessary and important for preventing continued viral transmission and initiating individuals on antiretroviral therapy. HIV diagnostic platforms must be efficient, cost-effective, easy to use, and applicable in a wide range of global healthcare settings. While several serologic immunoassays for the detection of HIV antibodies have been successfully adapted for point-of-care use, most combined immunoassays for the detection of HIV antibodies and HIV p24 antigen are limited to clinical laboratories. Here, we report the development of a microcantilever-based nanomechanical platform functionalized with broadly cross-reactive HIV-1 monoclonal antibodies for the rapid and sensitive detection of HIV-1 p24. The platform has a sensitivity in human serum as low as 1 fg/mL without relying on signal amplification. Furthermore, the assay yields results within 10 minutes. Data suggest that the technology may be sufficient to provide a quantitative reading of p24 in the serum, an important function of diagnostics used for the management/monitoring of HIV-1 viral load. This technology is promising for the future development of nanomechanical systems for use in rapid, point-of-care diagnostic tests for HIV-1 and other infectious diseases. Future work will look to optimize the blood processing method required to retain optimal sensitivity, expand the linear range, and account for subtype variations as needed.
Presenting author: Fiona Carter-Tod
Poster 13
Defining the Impact of Short-Term Surgical Education Courses in Low- and MiddleIncome Countries: A Systematic Review
Introduction There is a high burden of surgical disease in low- and middle-income countries (LMICs). One approach for improving surgical service delivery in LMICs is education of health professionals, including short-term education courses. The goal of this review was to evaluate short-term education courses in terms of content, evaluation, and impact. Methods A systematic review of the literature was performed in adherence with PRISMA framework. PubMed and EMBASE databases were queried using six predefined search terms to identify publications from 1990-2020. Two independent reviewers screened the records for inclusion and exclusion criteria. Studies of short-term courses (< 1 month) in LMICs that involved health care personnel and evaluated course impact were included. Results Of the 2640 records identified in the initial query, 45 articles were ultimately selected for inclusion in this systematic review. Thirty-three unique LMICs were represented, with eight courses held in multiple locations. The majority of courses were developed in high-income countries, lasted three days or less, and were intended for resident and attending doctors. While the specialty-focus of courses varied widely, nearly all courses aimed to teach both knowledge and skills, and the most common educational components included lectures and simulation and/or hands-on practical skills sessions. Written pre- and post-course knowledge testing was the most common method for evaluating course impact; however, there were a large variety of other evaluation methods including review of hospital metrics, clinical skills assessment, and participant survey. Conclusions Short-term education courses are held in many LMICs to teach a variety of procedural skills to surgical and anaesthetic providers. While there are similarities in course goals and educational components, there is substantial variation in methods used to evaluate course impact, as well as a lack of understanding the long-term retention of skills and impact on practice change and patient outcomes.
Presenting author: Jenny Zheng
Poster 14
Understanding Barriers and Facilitators to a Mobile Clinic HPV Screening Intervention
In Sub-Saharan Africa, especially in West Africa, Human Papilloma Virus (HPV) infection and their associated cancers are particularly serious. HPV-associated cancers, including cervical cancer, and anal and oral cancer, are largely preventable through HPV vaccination, screening, and early diagnosis and treatment. However, formidable challenges to implementation of large-scale, nationwide, prevention and control initiatives exist in LMICs, encompassing sociocultural, logistical and resource constraints. As a result, HPV infection is widely transmitted, and its related cancers go undiagnosed. This unfortunately results in many preventable deaths. Introducing innovative and context-specific strategies are crucial to prevent HPV-associated cancers effectively in LMICs, where local contexts must be carefully considered and addressed. The Robert J. Havey Institute for Global Health at Northwestern University was funded to develop a mobile clinic intervention to increase the number of women being screened for HPV infection. Within this space a woman would collect a cervical mucus specimen, via self-sampling. This sample would be analyzed by a lab technician to provide results, and then the woman would receive counseling and resources depending on the result. This mobile clinic intervention will be launched in four communities in Mali (Kita and Sikasso) and Nigeria (North Senatorial District and Peri-urban area of Ibadan, Oyo State.) To understand the barriers and facilitators from the perspectives of the community to this intervention, I will conduct an implementation science study prior to the intervention launch. I will utilize Consolidated Framework for Implementation Research (CFIR), focusing on the "Outer Setting" domain and two constructs: (1) Local attitudes, "sociocultural values (e.g., shared responsibility in helping recipients), and beliefs (e.g., convictions about the worthiness of recipients), that encourage support of implementation and/or delivery of the innovation" and (2) Local conditions, "economic, environmental, political, and/or technological conditions that enable and support implementation and/or delivery of the innovation." I will conduct four focus groups with key stakeholders (community, religious and administrative leaders). The focus groups will be recorded and transcribed and analyzed, using MAXQDA, by applying a constant comparative method to identify key themes. The findings will inform the community socialization aspect of the intervention.
Presenting author: Kate Klein
Poster 15
Understanding Linkages between Sexual and Reproductive Health Knowledge and Women's Empowerment: Survey Evidence from Rural Kenya
Studies have shown that interventions including a component on disseminating health knowledge, particularly knowledge related to sexual and reproductive health, can have lasting impacts on outcomes typically used to proxy women's empowerment. For example, four years after a vocational training and sexual and reproductive health campaign aimed at adolescents in Uganda, treatment communities saw a drop in teen pregnancy, early marriage, and sexual assault (Bandiera et al. 2020). In Cameroon, a school-based HIV prevention course yields an increase in condom usage and decrease in childbearing (Arcand and Wouabe 2010). Evaluation of HIV curriculum in Kenya reports that exposure to the curriculum results in a reduction in teen pregnancies one year later (Dupas 2011). Knowledge about HPV, and its link to cervical cancer, has the potential to be particularly empowering as it is literally lifesaving. Cervical cancer differs from other forms of cancer in that it is a preventable illness if detected early through HPV screening and treatment, and yet it remains the leading cause of cancer deaths in Kenya (Mwenda et al. 2022). Women who understand that early detection and treatment is key to preventing unnecessary death are equipped with the power to potentially save their own lives. Does an increase in knowledge around sexual and reproductive health increase women's empowerment? This research builds on a two-phase cluster-randomized trial conducted in 2016 to evaluate the effectiveness of a community-wide HPV education and screening intervention in promoting follow-up care in Migori County, Kenya (Huchko et al. 2018). Women in both the intervention and control groups received HPV and cervical cancer education and outreach from community health volunteers over a 2-week dedicated community health campaign. Following which, women in the intervention group received HPV screening in a centralized location within their village, and women in the control villages were screened at the local government health facility. A follow-up survey conducted in July 2022 was administered to 1,080 women living in these control and intervention villages to assess the long-term impacts of the RCT and the ways in which women were dealing with the ongoing COVID-19 pandemic. Drawing on these survey data, this project measures knowledge around sexual and reproductive health (including knowledge about HPV) and measures various aspects of women's empowerment (including health self-efficacy). In doing so, this research explores the connections between sexual and reproductive health and women's empowerment and highlights how health interventions can positively impact other aspects of a woman's life.
Presenting author: Kelly Hunter
Poster 16
Evaluating the Impact of Financial Navigation on Financial Toxicity and Treatment Adherence for Cancer Care: A Randomized Control Trial- COST-FIN
Introduction Low- and middle-income countries are projected to account for an estimated 75% of new cancer cases and 65% of cancer deaths globally. Nigeria, with >100,000 new cancer cases annually and a population of 218 million, has poor cancer survival outcomes (< 50% overall 5-year survival), at least partially due to poverty resulting in delayed diagnosis and suboptimal treatment. Patients diagnosed with cancer in Nigeria are at risk for financial catastrophe (FC) or financial distress (FD). Financial navigation programs (FNP) have been demonstrated to reduce financial toxicity among cancer patients. However, there is paucity of evidence on the implementation and impact of FNP interventions in Nigeria. This study aims to evaluate the impact of FNP on FC and FD among cancer patients in Nigeria. Methods This is a prospective randomized controlled trial of newly diagnosed (< 6 weeks from diagnosis) adults (≥18 years) with breast cancer, colorectal cancer, or prostate cancer at two sites in Nigeria: Lakeshore Cancer Center, Lagos (LCC) and Obafemi Awolowo Teaching Hospital Complex, Ile-Ife (OAUTHC). A projected total of 330 participants will be randomized 1:1 via block randomization to either the intervention (FNP) or the control arm, then followed for one year. Data on sociodemographic and clinical characteristics, prescribed cancer treatments, and finances will be collected via structured interviews at baseline, 3 months, 6 months, and 1 year from randomization. The primary outcome for this study is FC (defined by the World Health Organization as out-of-pocket costs that exceed 10% of household income, 25% of household expenditures or 40% of non-subsistence expenditures) during the follow-up period. Secondary outcomes include FD (measured by COST-FACIT score), cost of FNP, funding secured through FNP, and the proportion of participants insured. The impact of FNP on FC and FD will be assessed with two sample tests for difference in proportions. Multiple logistic regression with LASSO variable selection will be employed to identify factors associated with outcomes. An interim analysis will be conducted when 50% of 330 participants (recruitment target) have reached at least 6 months of follow-up. Conclusion This study will provide evidence on the potential role of FNP in eliminating financial barriers to cancer care and improving treatment adherence in Nigeria. These data on the feasibility, efficacy, and cost-benefit analysis of FNP. Our FNP model is designed to be simple and replicable in other low-resource settings.
Presenting author: Kristina Diaz
Poster 17
Using the Implementation Research Logic Model to Map and Measure Improving Quality: NEST360, A Multi-Country Alliance for Reducing Newborn Mortality in Sub-Saharan Africa
Background Small and sick newborn care (SSNC) is a new focus in low-resource settings. Newborn Essential Solutions and Technologies (NEST360) is a multicountry (Kenya, Malawi, Nigeria, Tanzania), interdisciplinary Alliance aimed at improving quality and impact through implementation of SSNC evidence-based interventions (EBIs) known to decrease newborn mortality. Strategies include increasing data comparability and use for multi-level quality improvement (QI). NEST360 co-developed strategies to enhance data availability, use and QI. We applied the implementation research logic model (IRLM) to articulate contextual factors, implementation strategies, mechanisms, and implementation outcomes to understand success of these initiatives. Methods Contextual factors were identified using adapted World Health Organization's Health System Building Blocks, while Proctor's implementation research outcomes framework defined the implementation outcomes in terms of increased data use and QI utilization. Data sources from 69 neonatal units included facility-level Neonatal Inpatient Data (NID) and a linked data dashboard (NEST-IT), program documents, peer-reviewed publications, ad team input to detail contextual factors and strategies. We analyzed existing program-level data, including data utilization reports and QI project documentation, to determine implementation outcomes. Findings We identified 37 contextual factors, 65% of which were barriers from 69 newborn wards in four countries. Fifteen strategies were implemented, including data audit and feedback, creation/use of a data dashboard (the NEST Implementation Tracker, "NEST-IT"), and QI training and coaching. Positive implementation outcomes included Reach (100% facilities logging into NEST-IT > once from October 2023-March 2024, and 90% facilities receiving QI coaching between April-June 2024). Additionally, 100% facilities conducted a QI project (Adoption), and 91% reported NEST-IT data in their QI project documentation (Feasibility) during April-June 2024. However, lower success was reported in data use (Adoption), with only 59% facilities logging into NEST-IT every month between October 2023-March 2024, and 58% of patient records being uploaded within two weeks of patient discharge (Fidelity) from July-December 2023. The need for additional strategies to support sustainment of improving quality efforts was also highlighted. Implications for D&I Science This study will inform ongoing work to improve quality, refine strategies and identify learnings to support increased coverage and quality of SSNC EBIs at NEST360- implemented facilities and improve neonatal outcomes.
Presenting author: Kylie Dougherty
Poster 18
Expanding Infrastructure for Genomic Surveillance and Bioinformatics in Low-Middle income Countries
The Center for Pathogen Genomics and Microbial Evolution (CPGME) at Northwestern University has been collaborating with partners in low-middle income countries (LMICs) to expand efforts in genomic surveillance of pathogens through molecular assays, whole genome sequencing, and bioinformatics. In 2024, we traveled to the University of Sierra Leone to teach a three-day bioinformatics workshop as part of the First International West Africa Symposium & Workshops on Infectious Disease. The curriculum was developed to instruct participants in whole genome sequencing technologies, data types, file management and processing, command line, alignments, and construction of phylogenetic trees. Materials were adapted from CPGME courses previously taught in Karachi, Pakistan and Lima, Peru. All curriculum was integrated into a GitHub that served as the instructional site for the course. The workshop utilized of a hybrid method of instruction with didactic lectures and hands on data tutorials in person and on zoom. Participants completed installation of all required software using provided pre-workshop materials. After successful completion of the workshop participants were able to understand data types, download sequencing data, trim and clean sequencing reads, compile a consensus sequence, perform alignments to a reference genome, create a de novo assembly, and create a simple phylogenetic tree. Seventy-three individuals applied to the workshop, 25 workshop applicants were selected and ultimately 19 participants attended the workshop. Eighty percent of participants were residents of Freetown, Sierra Leone; with the remaining participants residing in Cameroon, Nigeria, and the Central African Republic. The workshop consisted of a hybrid method of instruction with didactic lectures and hands on data tutorials. At the end of the 3-day period, a survey was distributed to all participants containing questions assessing the content and delivery of the materials. When rating the quality of the workshop overall on a scale of 1-5, with 5 being the greatest quality, students gave the course a 4.94/5. Students felt that the course was supplying them with an important skillset that they could use in their current job/studies, rating this aspect of the workshop 4.89/5. Sixty-eight percent of the participants responded that they would like additional instruction on the molecular biology components involved in genomic surveillance. We observed a high level of collaboration between the participants and among workshop facilitators. This workshop allowed us to evaluate the feasibility of working with internet-based data analysis methods in LMIC's, evaluate the needs of professionals in these settings, and identify key components and improvements to future workshops. Some challenges faced were rolling power outages, limited internet access, low availability of computers with basic bioinformatic analysis capabilities. Overall, feedback from our first workshop in West Africa included a large desire from participants to be able to generate and process genomics data at their home institutions, and they appreciated the ability to build a community over the workshop to share and exchange scientific resources in the future. We are currently exploring possibilities to expand this workshop series to include hands-on laboratory experiences, as well as expand to more locations around the globe.
Presenting author: Lacy Simons
Poster 19
Updates on Genomic Surveillance of Antifungal-Resistant Candida auris and Other Yeast in Pakistan: New and Expanding Threats
Recently emerged fungal pathogens such as Candida auris continue to cause outbreaks of infections in hospitals and other healthcare settings. Identifying and characterizing potentially emerging or unusual fungal pathogens using epidemiologic and molecular approaches are essential. Here we report the results of microbiologic and genomic surveillance of antifungal-resistant and unusual fungal pathogens processed at the Aga Khan University Hospital (AKUH) clinical microbiology laboratory in Karachi, Pakistan between 2021 and 2024. Specimens were obtained from 315 satellite collection units in 99 cities and towns across all four provinces of Pakistan. Species identification of fungal isolates cultured from patient specimens was performed using the VITEK 2 YST ID card and susceptibility testing was conducted using the YeastOne Sensititre YO10 system in the clinical microbiology laboratory at Aga Khan University Hospital in Karachi. DNA extracted from selected samples was shipped to the Center for Pathogen Genomics and Microbial Evolution at Northwestern University for whole genome sequencing (WGS). Sequencing libraries were prepared using the Seqwell Plexwell kit and sequenced on the Illumina Novaseq Platform. The number of Candida auris specimens cultured by the AKUH microbiology laboratory has remained consistent since 2022 with an average of 70 cases diagnosed per year. In contrast, the annual incidence of infections with other species of yeast have increased since 2021. These include bloodstream infections with yeast identified as Clavispora lusitaniae and Candida ciferri. Whole genome sequencing has revealed that the majority of these isolates were misidentified biochemically and instead belonged to Scheffersomyces spartinae and Candida blankii. Both S. spartinae and C. blankii are emerging pathogens and in Pakistan are causing bloodstream infections primarily in neonates, infants, and young children. We generated the first complete genome sequence of S. spartinae revealing that it consists of 8 chromosomes totaling 12.26 million bases in size. These results demonstrate the importance of capacity building to provide resources and expertise in genomic surveillance of pathogens to discover and track emerging fungal and other infections in Pakistan and around the world.
Presenting author: Lacy Simons
Poster 20
Factors Influencing Primary Health Care Utilization among Older Adults in Lagos State, Nigeria
Abstract Background: As the population in Nigeria ages, primary health care (PHC) is a critical, inclusive, and cost-effective approach to improving the health status and care for older adults who require regular care for noncommunicable diseases (NCD) and age-related conditions. To address healthcare disparities and promote healthy aging there is a need to identify barriers and facilitators to PHC access for older adults in Nigeria. Methods: We utilized a qualitative study design through focus group discussions with older adults in Lagos State. We did purposeful sampling and included adults aged 60 years and above, categorized as recent users (within the last six months) and past users (over six months ago) of PHC centers for the two focus group discussions (FGDs). A rapid thematic analysis was conducted to analyze data from the FGDs. Themes were identified using an inductive approach, with discrepancies resolved by consensus Results: We interviewed 19 participants in two FGDs. Using a healthcare accessibility and quality framework (5As), we identified shared barriers across both groups in multiple areas. These included Affordability (high cost of laboratory tests and medications), Adaptability (long wait times), Availability (frequent drug shortages, too few healthcare workers) and Appropriateness (lack of services tailored to meet the specific needs of older adults). Differences in barrier were also seen with recent users identifying the need for more compassionate care from healthcare providers (Acceptability), while past users advocated for improved services for chronic conditions and the availability of specialized equipment (Adaptability). Facilitators identified by both groups included the accessibility of PHC facility locations and user-friendly facility designs (Accessibility). Both groups stressed the importance of addressing the barriers to improve PHC service delivery for older adults including expanding health insurance coverage and system redesign. Conclusions: This study identified key barriers to and facilitators of PHC utilization by older adults that hinder access to healthcare. There are opportunities to improve the access, affordability, and delivery of age-friendly health services in primary healthcare facilities in Lagos, Nigeria, an area where future research is underway. Keywords: Barriers, Facilitators, Older adults, Primary health care, Utilization
Presenting author: Lilly Liang
Poster 21
Multimorbidity and frailty, and associations with quality of life among older adults in Rwanda
Background: The interplay between multimorbidity and frailty and their impact on quality of life in older adults in low-income countries remains understudied. This study examined the prevalence and associations between multimorbidity and frailty and their relationship with quality of life among adults in Rwanda. Methods: Cross-sectional data from a household survey of 4,369 adults aged ≥40 years in rural and urban Rwanda completed between March to July 2024 were analyzed. Multimorbidity was defined as having two or more chronic diseases, including hypertension, diabetes, hypercholesterolaemia, heart disease, stroke, cancer, HIV, cognitive impairment, symptoms of depression, or anxiety. Frailty was assessed using five criteria: low grip strength, self-reported exhaustion, weight loss, low walk speed, and low physical activity. Quality of life was evaluated using the eight-item EUROHIS-WHOQoL scale, with total scores ranging from 8 to 40 normalised to a 0–100 scale, where higher scores indicate better quality of life. We used multiple logistic regression to examine the associations between multimorbidity and frailty, while linear regression analysis was used to assess the relationships with quality of life. Results: The prevalence of multimorbidity was 55.2% (95% CI: 53.7, 56.6), with significantly higher rates among females (59.1%) compared to males (48.4%). Additionally, 14.5% (95% CI: 13.5, 15.6) of participants were diagnosed as frail, with significantly higher rates among individuals aged 70 years and older (32.3%), females (17.7%), those in the poorest wealth quintile (22.8%), and rural residents (24.2%). Among frail individuals, 75.7% also had multimorbidity, while 20.0% of those with multimorbidity were frail. After adjusting for potential confounders, multimorbidity was significantly associated with frailty (aOR = 2.43, 95% CI: 1.93, 3.05), and both conditions were independently associated with lower quality of life scores. Compared to non-frail individuals or those without multimorbidity, frail individuals and those with multimorbidity had significantly lower quality of life (β = -9.34, p < 0.001; β = -5.37, p < 0.001, respectively). Interaction analysis revealed that the combined effect of frailty and multimorbidity further exacerbated the decline in QoL by an additional 4.19 percentage points compared to either condition alone (β = -4.19, p = 0.009). Conclusions: Multimorbidity and frailty are common among older urban and rural adults in Rwanda and were associated with lower quality of life. The strong association between these conditions suggests the need for early identification and management of comorbid conditions and frailty using integrated care approaches to improve health and quality of life among older adults in Rwanda. Keywords: multimorbidity, frailty, quality of life, aging, Rwanda Funding: The authors would like to acknowledge the financial support of Robert J. Havey, MD Institute for Global Health at the Northwestern University through The Northwestern Havey Institute for Global Health Global Innovation Challenge award (1001E).
Presenting author: Lilly Liang
Poster 22
Global Surgery Opportunities for Medical Students: A Scoping Review
Introduction: The field of global surgery focuses on providing surgical care in low-income countries, and it is essential to decreasing the global burden of disease, 1/3 of which is due to lack of access to safe, surgical care (Vaghaiwalla et al., 2023, InciSioN 2021). However, exposure to global surgery is limited especially for medical students (InciSioN 2022). Several survey-based studies demonstrated that most medical students agree that global surgery is relevant to medical education and that more exposure to global surgery is needed before residency (InciSioN 2021, Scott 2019, Rennie 2023, Salgado 2022, Moren et al. 2015, Padmanaban et al., 2020). To our knowledge, there is a dearth of literature investigating US medical students' knowledge, perspectives, and level of exposure to the field of global surgery and the accessibility of global surgery education opportunities. The aim of this scoping review is to determine what opportunities are available for U.S. medical students and what work has been done to investigate the impact of these global surgery initiatives on the career and interests of medical students. Methods: The scoping review followed PRISMA 2018 and the JBI scoping review methodology (Peters et al., 2020). A search was conducted in the electronic databases of Embase, Medline, and Scopus, with relevant terms such as: global surgery, medical education, knowledge, and perspective. The search was limited to studies performed between the years 2000-2024 and studies published in English. Data extraction was performed independently using Covidence. Results: We identified 262 articles for screening. The criteria for inclusion were a focus on US medical students, global surgery as opposed to global health in general, and an assessment of knowledge, perspectives, or level of exposure. 18 studies were screened at the full text review stage. We included 5 studies for analysis. 4 of those 5 studies evaluated a curricular intervention with an international component, and all interventions resulted in improved knowledge of global surgery as measured by post-intervention surveys and thematic analysis of student feedback. Conclusions: Despite limited exposure to global surgery in medical school, the majority of students valued global surgery education and expressed strong interest in the field. Overall, this review identifies a clear gap in the literature on the topic of medical students' perspectives in the area of global surgery and justifies the need for a more focused effort in identifying opportunities for medical students that will increase their exposure to global surgery.
Presenting author: Maya V. Roytman
Poster 23
Impact of a Gaza Healthcare Workshop on U.S. Medical Students' Understanding
Background: As medical education in the United States adapts to a rapidly globalizing world, medical students face an increasing need for exposure to healthcare systems and issues outside of U.S. borders. Traditional curriculums, however, often lack components that adequately cover the structures, challenges, and socio-political impacts on health in overseas medical contexts. In this regard, a focused emphasis on global health education within medical school curricula could bridge this knowledge gap, equipping future physicians with a broader, more holistic understanding of healthcare systems. This study highlights the knowledge gaps present in U.S. medical students' understanding of healthcare systems abroad and evaluates the effectiveness of a workshop specifically focused on Gaza's healthcare infrastructure during war. By incorporating such workshops, medical schools can foster increased global health awareness, advocacy, and ultimately a commitment to equitable healthcare practices. Methods: A retrospective survey was conducted following an optional workshop that detailed the healthcare system in Gaza, addressing both recent structural changes and the broader effects of war on population health. The survey aimed to assess changes in students' understanding of healthcare systems abroad, interest in global health advocacy, and perceived knowledge disparities. Additionally, we compared student responses regarding their interest and preparedness for global health work before and after the workshop. Using a Likert scale (1-5), we assessed students' self-rated interest in global health and perceived knowledge about Gaza's healthcare system, with higher scores indicating stronger interest or greater knowledge. Results: Preliminary data were collected from 16 workshop attendees (53% of total participants). On a 5-point Likert scale, while students reported moderately high interest (3.8/5) in pursing medical work abroad, they felt underprepared (2.6/5) by their medical education for global work. After the workshop, the majority (84.6%) reported an increased interest in global health advocacy, with most scoring their interest level at four or higher. Students consistently rated their agreement with positive statements about the workshop's impact with average ratings ranging from 4.53 to 4.85, indicating strong agreement. Students reported improvements in their knowledge of Gaza's public health challenges, medical supply shortages, and the impact on vulnerable populations during war. Students showed significant improvements in knowledge about Gaza's healthcare infrastructure, increasing from 3.8 to 7.3 on a 10-point scale (p ≤ 0.0001, 95% CI [-4.31, -2.31]). Conclusions: This study underscores the potential impact of integrating global health workshops into medical school curriculums. The positive shift in student interest and self-assessed knowledge following the Gaza healthcare workshop suggests that such interventions can effectively address educational gaps. By fostering awareness of international healthcare issues and encouraging advocacy, these workshops provide students with a crucial foundation in global health, preparing them for future work in diverse healthcare settings and ultimately contributing to a more globally minded medical workforce.
Presenting authors: Ramzy Issa and Osama Hassan
Poster 24
An Analysis of Trauma-Induced Amputation Care in Middle Eastern Conflict Zones
Background: In conflict zones within the Middle East, care for trauma-induced amputations poses significant challenges due to collapsing healthcare systems and infrastructure. The ongoing conflicts in countries such as Syria, Yemen, Iraq, Lebanon, Palestine, and Iran have led to a surge in traumatic injuries resulting in limb amputations. This study examines the current state of healthcare for individuals with conflict-related limb amputations in this region and identifies critical areas for improvement in healthcare education and practice. Methods: A comprehensive literature review spanning from 2000 to 2024 was conducted, analyzing studies from the aforementioned Middle Eastern countries. The initial search in PubMed and Google Scholar yielded 56 unique articles, of which 15 met the inclusion criteria. Data extraction focused on prevalence, amputation types, healthcare access, rehabilitation services, and quality of life measures for amputees in conflict-affected areas. Results: Key findings involved prevalence of post-amputation complications. Six out of the 15 research articles addressed post-amputation infections, with one reporting infection rates as high as 92.5%. Two studies delineated additional complications: one reported a 53% non-union rate in tibial fractures and another found 44.8% of amputees had metal fragments in the affected region post-amputation. Delays in accessing rehabilitation services were characterized in four studies, with one study noting an average of 8.2 years between traumatic amputations and rehabilitation. The availability and use of prosthetics varied widely, with usage rates ranging from 30-80% across studies. Five articles discussed the impact that war places on healthcare systems, highlighting widespread damage to facilities and the surrounding environment. High unemployment rates among amputees (up to 75%) and chronic pain post-amputation (discussed in 5 studies) contributed to psychological distress and reduced quality of life. Conclusions: Poor healthcare infrastructure during conflict impacts access to treatment, postoperative care, rehabilitation, and poses physical barriers due to collapsed infrastructure. To address gaps in delivery, healthcare education and practice should focus on developing specialized trauma care and rehabilitation programs, improving quality of and access to prosthetic services, and integrating psychological support into standard care protocol.
Presenting authors: Ramzy Issa and Ziad Fehmi
Poster 25
Unraveling RSV through Whole Genome Sequencing in Chicago
Respiratory Syncytial Virus (RSV) is one of the leading annual causes of respiratory tract infections, infecting nearly all infants in the United States by age two. RSV imposes a significant disease burden on individuals over the age of 65 and immunocompromised populations. RSV is a single-stranded, negative-sense RNA virus that mutates frequently, complicating the development of effective treatments. However, in 2023, the FDA approved two RSV vaccines (Arexvy and Abrysvo) and a monoclonal antibody, nirsevimab. Nirsevimab binds to the RSV F fusion protein, blocking viral entry and preventing replication. A previous study using publicly available sequences from before 2020 showed low frequency of substitutions in the nirsevimab binding site, indicating that the RSV fusion protein remains conserved and susceptible to nirsevimab. As nirsevimab is administered to infants to protect against RSV, it may create selective pressure favoring RSV strains with mutations in the F protein that reduce the effectiveness of nirsevimab. Although RSV frequency has surged recently due to relaxed mitigation measures and waning immunity, genomic surveillance is limited. Thus, surveillance is critical as mutations in viral drug or vaccine targets can significantly reduce efficacy. We hypothesized that Nirsevimab administration will increase RSV F mutations during the 2023-2024 RSV season. To test this hypothesis, we leveraged a 252 RSV positive diagnostic nasopharyngeal swabs from Northwestern Medicine to generate whole genome sequences (WGS). We generated amino acid mutational frequencies of the F proteins from the WGS to identify the emergence of nirsevimab-resistant mutations. Subsequently, phylogenetic analysis was employed to examine the genetic divergence of the 2023-2024 isolates from our prior existing WGS data from 2017-2023. We observed a substitution prevalence of I206M Q209R S211N on RSV-B F has increased leading to an increase of 98% mutational frequency (is this the right way to write this). More immediate future directions include testing the role of mutations in viral entry and antibody neutralization and conducting further analyses using larger population samples. Broader future directions aim to increase genomic surveillance to monitor nirsevimab escape mutants, ensuring the efficacy of future therapeutic and monoclonal antibody designs. Additionally, this will improve our understanding of RSV seasonality, disease burden, and genomic evolution.
Presenting author: Ria Almohtadi
Poster 26
Barriers to Care for Children Born with Myelomeningocele in Zambia: Provider Perspectives
Introduction: Myelomeningocele (MMC) represents the most severe form of a neural tube defect. Early surgical closure of MMC reduces infection rate and mortality. Zambia is a lower-middle income country with no folic acid fortification program, resulting in a high burden of MMC. There are only two tertiary care hospitals offering neurosurgical services in Zambia, and neither offer fetal MMC surgery. The median age of MMC repair in Zambia is 21 days, suggesting that patients may face various barriers in seeking, reaching, and receiving care. Objectives: To characterize Zambian healthcare provider perspectives to identify barriers to care for patients with MMC. Methods: A mixed methods survey was administered to healthcare providers at Zambian public health facilities. The survey consisted of 22 multiple choice questions on clinical workflow and referral patterns, with three free text questions regarding targets for improved care of patients with MMC. Descriptive and thematic analysis was performed. Results: Thirty-two providers from 9 referring health facilities completed the survey. Ninety-seven percent (N=31) indicated the ability to diagnose MMC in an infant. 56% (N=18) responded that MMC diagnosis was made after birth, while 16% (N=5) indicated that diagnosis was made on ultrasound in-utero. 65% (N=21) of providers refer MMC patients for further management within 6 hours of birth. Only 50% (N=16) of providers indicated that MMC patients at their facility received antibiotics. Thematic analysis identified 4 themes for improvement of care: 1) strengthening prevention and antenatal care, 2) improving referral and transfer systems, 3) social and financial support for families, and 4) educating communities about MMC. Conclusion: Zambian providers recognize and diagnose MMC early. However, delayed interfacility transfers affect timing of surgical treatment. Providers identified prevention with folic acid fortification, access to prenatal diagnosis, and antibiotics as focus areas of improvement in the care of Zambian infants born with MMC.
Presenting author: Rya Muller
Poster 27
Caring for Care Givers
Background: The surge in armed conflicts since the mid-2000s, has significantly disrupted healthcare systems, leading to humanitarian crises and profound economic and infrastructure damage. This study examines the impact of the Tigray conflict on healthcare systems, professionals' livelihoods, community health, and healthcare services. Methods: A qualitative study using a phenomenological approach was conducted in Tigray Regional State, Ethiopia, involving in-depth interviews with health professionals. Participants were selected through purposive sampling, focusing on those with clinical and administrative roles during the conflict. Data collection occurred between February and March 2022, with interviews conducted in Tigrigna. Results: The conflict has devastated Tigray's healthcare infrastructure, leading to a collapse of health services and a significant decrease in healthcare professionals' quality of life. The community's health has deteriorated due to reduced healthcare access and increased disease prevalence. Key themes identified include the perils of war on a thriving health system, a community hanging by a thread, and resilience and hopes for recovery. The study highlights the urgent need for focused interventions to mitigate the conflict's impacts and foster long-term recovery in the region. Conclusion: The Tigray conflict has had a profound impact on the healthcare system, professionals, and community health. The findings underscore the necessity of immediate, coordinated efforts to rebuild the health sector, support affected professionals, and enhance community health resilience. This study provides crucial insights into the challenges faced by healthcare systems in conflict zones and the importance of safeguarding these systems against the ravages of war.
Presenting author: Samuel Kidane
Poster 28
Impact of COVID-19 on Medical School Global Health Experiences
Background International global health experiences have long been an important and sought-after opportunity for medical school students motivated by an interest in improving health equity and reducing disparities (Sopdie & Prasad, 2022). By participating in a rotation or project, students expand their understanding of health care systems, access, and cultures in different contexts (Lawrence et al., 2020). This has served to improve clinical and social aspects of patient care (Imafuku et al., 2021). The ability to participate in these programs or rotations were significantly impacted by the COVID-19 pandemic and related restrictions on travel (Storz, 2022) (Prescott, 2020). Objective This comparative analysis aims to evaluate medical school student participation in international global health experiences before and after COVID-19, grouped by World Bank country income classifications and compared against national rates of student participation in global health experiences. Methods We examined internal records of student participation in global health experience at the Northwestern Feinberg School of Medicine (FSM) and as tracked nationally by the Association of American Medical Colleges (AAMC). For the purposes of this assessment, only Northwestern-sponsored student experiences will be included in the internal data. This includes medical, physician assistant, physical therapy, and Master of Public Health students. Only 4th year FSM medical student information was compared against AAMC data from their annual Medical School Graduation Questionnaire (GQ). Results According to the data for students at FSM , the highest number of rotations and projects were carried out at Affiliated Partner Sites in Upper-Middle Income Countries both before and after COVID-19. Overall, engagement with partner sites, as grouped by country income level, has followed a similar pattern as the levels pre-COVID. In the 2017 – 2018 academic year, student participation numbers by country income level were as follows: 55.4% (n=67) in Upper-Middle Income (UMIC) , 24.0% (n=29) in High-Income (HIC), 13.2% (n=16) in Lower-Middle Income (LMIC), and 7.4%(n=9) in Lower-Income (LIC). Whereas in the 2023-2024 academic year, 58.3% (n=42) fell within Upper-Middle Income (UMIC), 22.2% (n=16) in High-Income (HIC), 18.1% (n=13) in Lower-Middle Income (LMIC), and 1.4% (n=1) in Lower-Income (LIC). When comparing FSM's 4th year medical student global health rotation numbers to the AAMC nationwide data, we found that the FSM student rotation rate was consistently higher that that of the AAMC. In the 20017-2018 academic year, the rate of 4th year medical student engagement in a global health experience at FSM was 57.1% and the national U.S. medical student rate was 27.1%. In the 2023-2024 academic year, 4th year medical students saw an engagement rate of 39.1% compared to a national rate of 12.9%. Conclusion Overall, the rate of engagement has out-paced the national average. Still, FSM student participation has not yet risen proportionally to the levels observed pre-COVID-19. Of note, the pattern of student engagement by country grouping does align with previous levels. Given that FSM students receive funding support for international global health experiences, these findings suggest that there are additional social, environmental, or organizational factors that may be influencing the rates of engagement.
Presenting author: Sara Caudillo
Poster 29
The Missing Millions: Uncovering the Burden of Covid-19 Cases and Deaths in the African Region
Early in 2020, experts warned of the devastating toll that COVID-19 would have on African countries. By the close of 2021, however, Africa remained one of the least affected regions in the world, leading commentators to speculate about a so-called "Africa paradox". This review evaluates current research and data to establish the burden of COVID-19 infections and mortality in the African region. Despite claims that African countries were spared from COVID-19 infection, there is now considerable serological evidence confirming that people in African countries ultimately experienced levels of SARS-CoV2 infection comparable to or more than people in other global regions. Additionally, multiple measures demonstrate substantial impacts of COVID-19 on mortality in specific African countries where mortality and/or seroprevalence data are available. The gaps between recorded cases and seroprevalence are large and increased over the course of the pandemic. Researchers also observe significant gaps between recorded COVID-19 deaths and other measures of mortality, attributable to weak civil and vital registration systems, limited health care resources, and higher mortality at younger ages. Our findings reinforce the need for more equitable global distribution of health care resources and expanded disease and mortality surveillance across the continent.
Presenting author: Serena Musungu
Poster 30
Age-related comorbidities and quality of life among older people living with HIV in urban Tanzania
Background Approximately one-third of Tanzanians living with HIV are aged ≥50 years. Aging persons living with HIV (PLWH) are at a higher risk of multi-morbidities compared to persons without HIV. These can have a significant negative impact on quality of life (QOL). This study assessed the distribution of geriatric and medical comorbidities and their impact on the quality of life in older PLWH in Tanzania to highlight the growing complexities of care in this population and inform future strategies to improve well-being. Methods This cross-sectional study was conducted among PLWH at seven HIV clinics in Dar es Salaam, Tanzania. Participants were included if they were aged ≥50 years, on ART ≥3 years, and in HIV care ≥12 months. Geriatric comorbidity screening included Fried's Frailty phenotype score (frailty), PHQ-9 (depression), community screening interview for dementia (CSI-D), and WHODAS 2.0 (ADLs). QOL was assessed using the WHOQOL-HIV-BREF. Fasting blood glucose, lipid profile, and serum creatinine were also measured. eGFR was calculated using the 2021 CKD-EPI equation. Multivariable linear regression was used to examine the association between aging outcomes and QOL scores. Results 400 older PLWH were enrolled [mean age (SD): 58.6 (±6.9); 50% female; mean duration on ART: 11.8 (±1.8) years]. 86% were on DTG-based ART and 73% were virally suppressed (< 50 copies/mL). Sex differences were observed in medical and geriatric co-morbidities (Table 1). The mean (SD) QOL score was 74.2 (±12.2), with the highest scores in physical, spiritual, and social relationships domains. Females vs. males had lower scores in overall QOL (73 vs. 76, p=0.02), independence (69 vs. 73, p=0.02), and environment (60 vs. 66, p< 0.01). Pre-frailty (β=-4.70, 95% CI:-7.31,-2.07, p< 0.01) and frailty (β=-5.52, 95% CI: -9.81,-1.23, p=0.01), impaired ADLs ≥1 (β=-6.34, 95% CI:-9.04,-3.64, p< 0.01), mild depression (β=-9.06, 95% CI:-11.90,-6.21, p< 0.01) and moderate/severe depression (β=-16.67, 95% CI:-21.39,-11.94, p< 0.01) were all associated with worse QOL. Conclusion A high prevalence of geriatric and medical comorbidities in this relatively young aging population was observed which negatively impacted QOL. These findings highlight a need for screening and prevention of geriatric clinical and psychosocial conditions in PLWH aged ≥50, particularly women.
Presenting author: Theresia Ottaru
Poster 31
A Role for Case-Based Artificial Intelligence-Augmented Simulations in Medical Training and Pandemic Preparedness
Introduction Simulation-based training (SBT) is an essential component of medical education, offering trainees a safe and yet realistic environment to practice medicine in high-risk scenarios without endangering real patients. SBT includes high-fidelity mannequins with electronic features, standardized patients in clinical scenarios, and virtual reality environments. Despite their educational benefits, these programs demand considerable faculty time and resources. Consequently, there is growing interest in digital simulation software as a more resource-efficient alternative for international and lower-resource settings. Virtual Patients and Artificial Intelligence in Case-Based Simulation Virtual patients (VPs), computer-based programs simulating real patients, are gaining traction in medical education. VPs simulate interacting with a real patient by allowing the learner to obtain a history, discuss the patient's condition, and make therapeutic and diagnostic decisions. Studies indicate that students using VPs achieve comparable or improved knowledge and skill learning to those trained traditionally. VPs offer a resource-efficient solution, accessible anytime and anywhere, making them a valuable tool for improving clinical skills and communication in lower-resource settings where smart phone access is high, but simulation laboratory infrastructure is low. Incorporating Artificial Intelligence (AI) into simulation software represents a promising frontier for cost-effective and dynamic SBT by providing personalized learning experiences and adaptive assessments. AI-augmented VP simulators offer learners high-fidelity simulation experiences that can adapt to their responses and provide customized feedback. Pandemic Preparedness The likelihood of another pandemic in the next century is high, with epidemics across the world remaining a constant concern. The highly dynamic and modular nature of an AI case-based simulator could be beneficial in global pandemic preparedness, enabling rapid training of medical staff to recognize and manage rare diseases. AI-based simulators can quickly integrate new diseases into training modules, improving staff awareness and competence, regardless of geography. For instance, a simulator for Ebola virus disease (EVD) could aid clinicians in recognizing early symptoms, thereby improving early detection and treatment in an area where EVD is not endemic. Though in-person simulation center training boosts confidence in managing EVD, these courses are expensive and time-consuming. A Case-Based Simulator for Ebola As a proof of concept, we demonstrate the usage of a case-based simulator using VPs to describe how an online simulator may be of use in the early detection and treatment of a rare virus, like EVD, by clinicians in a global setting. We based the case on a fictional patient: a 29-year-old woman who had unknowingly visited an area with an EVD outbreak and then returned to the US. This is a hypothetical case based on the Sudan ebolavirus outbreak in western Uganda in 2022. Methodology and Challenges Our simulator employs State of the Art reasoning capabilities, using large language models to develop comprehensive SBT cases. While AI offers vast potential, it poses challenges like inaccuracies, bias, and privacy concerns. These risks can be mitigated by providing AI models with comprehensive information and verifying outputs. Conclusion SBT that uses VPs and AI can further enhance case-based simulations, benefiting routine medical training and emergency preparedness in a global health setting.
Presenting author: Veronica M. Boratyn
Poster 32
Assessing the Impact of Ecosystem Health on Societal Vulnerabilities to Extreme Weather Events Using AutoML
"Background Extreme weather events are increasing in frequency and intensity, posing significant threats to both ecosystem health and societal well-being. Understanding the interactions between ecosystem vitality and societal consequences of these climate extremes is crucial for effective mitigation strategies. Machine learning techniques offer tools to explore these relationships and provide actionable insights. This project displays part of a broader initiative of exploring the flow from climate change to socioeconomic impacts. Objective This study aimed to investigate how ecosystem health metrics influence societal vulnerabilities and consequences of extreme weather events. We leveraged machine learning models to understand the links between ecological indicators and the impacts of climate extremes on human populations. Methods We used two datasets: the Yale Environmental Performance Index (EPI) dataset, containing environmental indicators related to ecosystem vitality and health, and the World Bank dataset, detailing societal impacts from extreme weather events. Indicators included greenhouse gas emissions, PM2.5 exposure, and biodiversity habitat index, while the societal impacts covered deaths and injuries from natural disasters. The Tree-based Pipeline Optimization Tool (TPOT) was used to find the best model for predicting societal impacts based on ecological metrics. The SHAP value and partial dependence plots will be used to visualize feature influence. Results Currently the best performing model is the ElasticNet. Eventually, the final model will provide insights into the impact of ecosystem health metrics on societal consequences of extreme weather events. Factors significantly affected mortality and injury rates during climate extremes will be highlighted, offering guidance for policymakers."
Presenting author: Yingxuan Liu
Poster 33