We are delighted to announce the 2022 Center for Global Health Equity University Scholars! This year, we are honored to announce the inaugural Donna and George Lyle Family Global Health Scholarship awardees. Endowed awards represent a special honor; we are grateful to our donors for their generosity and commitment to sustaining opportunities.
2022 Donna and George Lyle Family Global Health Scholarship
Maria Geba, School of Medicine, Infectious Disease Fellow, 2024
Katherine Hall, School of Nursing, Doctoral candidate, 2024
Anneda Rong, College of Arts & Sciences, 2022, Major: Statistics
Project: Collaboratively adapting a telebehavioral mobile application to enhance patient-provider communication regarding cervical cancer prevention efforts in Bluefields, Nicaragua
Globally, there are 500,000+ women diagnosed with cervical cancer every year with 250,000+ deaths. However, nearly 90% of deaths occur disproportionately in low- to middle-income countries largely due to barriers in access to preventative strategies such as HPV vaccines and cervical cancer screening. Nicaragua has the highest rate of cervical cancer diagnoses compared to all other Central American countries and is the leading cause of cancer death in Nicaraguan women. Although free cervical cancer screening is offered through public clinics, these services are underutilized with only 10% of eligible women engaging in screening. Though HPV vaccines are offered at a cost, Nicaragua is the only Central American country not to adopt a national vaccination program yet.
The World Health Organization has committed to eliminating cervical cancer incidence/mortality by one-third, by 2030. For more than a decade, Dr. Mitchell has centered her research program on fulfilling that goal in Nicaragua. In 2020, after years of collaboration and preliminary work with partners, a telebehavioral, patient-centered mobile application called Azulado was developed to increase cervical cancer prevention, screening, and treatment in Bluefields, Nicaragua. Azulado was culturally, linguistically, and regionally created to specifically meet the needs of women in Bluefields and was successfully piloted by this community in the summer of 2021. Using the app, women have educational resources about cervical cancer, are also able to interact with each other on discussion boards and can contact research team members. The next phase of this project will be to develop a patient-provider portal in Azulado that will connect women to their local healthcare providers and clinic staff where they can ask questions about their medical care and be notified of test results as they are available.
2022 Joy Boissevain Scholar Award for Global Public Health
Stella Alexiou, College of Arts & Sciences, 2025
Major: Global Public Health, Minor: Anthropology + African American Studies
Project: Assessing Appalachian Perspectives of Healthcare
Appalachian healthcare is one of the neglected healthcare systems in the country; “healthcare deserts” fill the region due to low outside investment rates and scarce healthcare professionals, and in the rare place where care is provided, it is often of poor quality. These factors combine to create a region with dangerously high mortality rates. Yet, despite these pressing healthcare disparities, little is known about Appalachian perspectives about and perceptions of healthcare. While research has been conducted about Appalachian medical professionals’ views or on public opinions of issues found within the regions (such as the opioid crisis), little focus is on the citizens’ views of the healthcare systems in which they participate. This research aims to explore these views. Understanding citizen perspectives is crucial to further adapt the system to fit the needs of the patients rather than just those of healthcare providers as well as to address educational gaps regarding healthcare within the area. Furthermore, this study seeks to determine how these perspectives have been influenced by the level of care given to the region’s citizens.
2022 Pamela B. and Peter C. Kelly Award for Improving Health in Limpopo Center for Global Health Equity Scholar Award
Julia Davis, School of Engineering and Applied Sciences, 2022, Major: Civil Engineering, Minor: Engineering Business, Frank Batten School of Leadership and Public Policy, Masters in Public Policy, 2023
Maya Reese, School of Engineering and Applied Sciences, 2025, Major: Chemical Engineering
Jamie Harris, School of Engineering and Applied Sciences, Doctoral candidate in Civil and Environmental Engineering, 2023
Project: Evaluating the Water Quality Benefits of Adding a MadiDrop+ to Household Water Filters in Limpopo, South Africa
In 2020, 1 out of 4 people did not have safely managed drinking water in their homes. In South Africa alone, 2.11 million people lack access to any safe water infrastructure. Drinking untreated water can transmit waterborne diseases such as cholera, dysentery, and typhoid. A common symptom of these diseases, diarrhea, is the second leading cause of death in children under 5 years old. Interventions at the household (point-of-use) can reduce the pathogen load in drinking water to decrease instances of diarrhea and death. Point-of-use water treatment (POUWT) occurs after the water has been collected and right before consumption.
Chemical disinfection by chlorine is widely used to treat drinking water in low-cost settings. However, chlorine changes the taste and odor of water and has the potential for harmful disinfection by-products. Alternatively, silver does not change the taste or odor of drinking water. A product developed at the University of Virginia, called the MadiDrop+, uses silver as a chemical disinfectant. The MadiDrop+ is a ceramic tablet embedded with metallic silver patches. The tablet is placed into 10-20 liters of water and gradually releases silver ions for a 3-4 log reduction of coliform bacteria. A single MadiDrop+ can be used daily for one year, but requires at least 8 hours of contact time for sufficient disinfection.
Water filtration is also a common and low-cost approach to household water treatment. The Kohler Clarity is a gravity-fed, two-stage filter with a ceramic cartridge that must be replaced every four months. There is no mechanism in place to prevent recontamination in stored water. A 2013 study in Fiji found that 76% of households with POUWT filters still had bacterial contamination in their stored water.
2022 Sister Bridget Haase Center for Global Health Equity Scholar Award
Courtney Rogers, School of Engineering and Applied Sciences, Doctoral candidate, Systems Engineering, 2023
Sophia Jang, College of Arts & Sciences, 2024, Major: Undeclared (Anticipated: Global Public Health, English); Minor: Undeclared (Anticipated: Data Science)
Project: Examining inequities in transportation access to maternal health services
Maternal mortality rates remain unacceptably high among minoritized populations in the U.S. Racial and ethnic disparities in maternal health outcomes are exacerbated by income status, as low-income minoritized individuals are more likely to face housing instability, food insecurity, and chronic conditions, which are all social determinants of health (SDoH) that contribute to adverse maternal health outcomes. SDoH are particularly important to address as a recent Surgeon General’s Call to Action specifically emphasizes the need to address SDoH that contribute to racial and ethnic maternal health disparities, especially among low-income populations.
Transportation access is one such determinant that impacts maternal health as structural racism embedded in transportation infrastructure has unjustly distanced minoritized populations from health care and public services. Current research on this topic is mostly limited to quantitative and geospatial data. Expanding our understanding of transportation access through qualitative research is necessary to elucidate the elements of the cultural, social, political, and technological environments that affect transportation access. Current qualitative research on transportation access is also limited to a single aspect of maternal health care, failing to holistically consider a variety of services that promote maternal health (e.g. ob-gyn care, behavioral and mental health services, and Woman, Infants, and Children (WIC) program sites and vendors).Therefore, our limited knowledge of the contextual factors influencing transportation access across fragmented systems prevents health care and human service professionals from fully addressing barriers to maternal health care and services.
This research will utilize principles from community-based participatory research to develop an innovative systems mapping method that integrates theories from public health and systems engineering to identify the contextual factors shaping transportation access among low-income minoritized individuals to maternal health care services and elucidate the intricacies of their relationships.
2022 Glenn and Susan Brace / Center for Global Health Equity Scholar Award
Christle Ann de Vera, School of Nursing, Clinical Nurse Leader, 2023,
Zixiao (Annie) An, College of Arts & Sciences, 2022, Major: Human Biology, Statistics (Biostatistics concentration)
Annicole Buranych, School of Nursing, Masters of Science in Nursing, Clinical Nurse Leader, 2023
Project: Features and outcome of patients with severe and critical COVID-19 at the University Teaching Hospital of Butare during the third wave of the pandemic: A retrospective cross-sectional analytical study.
Our group will be supporting the research study written and conducted by Dr. Dona Fabiola Gashame, the principal investigator (PI) of this project. This is part of an ongoing collaboration between the University of Virginia and the University of Rwanda that has existed for many years. Any publication or poster created out of this project will be co-authored by the PI.
The purpose of this research is to identify the clinical manifestations and outcome of severe and critical COVID-19 patients at the University Teaching Hospital of Butare (CHUB). Using a retrospective cross-sectional analytical study of hospitalized patients, individuals over the age of 18 who were admitted to the Intensive Care Unit (ICU)/High Dependency Unit (HDU) between May 2021 to October 2021 with a diagnosis of laboratory-confirmed SARS-CoV-2 will be screened and included in this study. Data to be collected includes the social demographic characteristics and clinical characteristics of the participants. However, due to limitations of a retrospective cross-sectional study, some variables (i.e., preadmission symptoms or symptoms duration prior to admission missing from history) may not be available to assess.
The PI uses the clinical symptoms described by the National Institute of Health (NIH) to classify illness severity of patients at CHUB. According to the NIH, patients infected with SARS-CoV-2 manifest severe illness with SpO₂ <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) < 300 mm Hg, and a respiratory rate > 30 breaths/min or lung infiltrates > 50% (2021). In addition, the World Health Organization (WHO) characterizes lung infiltrates as opaque bilaterally or as a respiratory failure without volume overload or lobar collapse (2020). The NIH continues that patients who present with critical illness have respiratory failure, septic shock, and/or multiple organ dysfunction (2021)
2022 Center for Global Health Equity University Scholars
Abigail Thornbury, College of Arts & Sciences, 2023, Major: Biology
Gabriella L. Hopper, College of Arts & Sciences, 2023, Major: Echols Interdisciplinary Major- Human Health
Healthy in the Hills Produce Prescription Project
According to 2019 America’s Health Rankings data, West Virginia has the highest rates of diabetes (16.2%), obesity (39.5%), and high blood pressure (43.5%) in the nation. The Healthy in the Hills Produce Prescription Project is a community-engaged initiative that will be conducted by UVA and Williamson Health & Wellness Center (WHWC), a Federally Qualified Health Center. This study aims to improve health outcomes via two routes: incentivizing fruit and vegetable consumption and increasing nutritional knowledge. A total of 535 participants will be consented and enrolled in 3 sequential cohorts, each lasting 6 months. During the 18-month study period, a produce prescription system will allot participants $60/month to spend on produce at WHWC Farmers Markets and educational events will be led by WHWC staff. Participants will also be given a monthly pre-packed food box valuing $20. Participants will meet with WHWC staff, trained in motivational interviewing, throughout the study period to set healthy eating goals. Accommodations will be made for participants who are unable to travel to WHWC locations. Pre- and post- surveys will be used to analyze changes in participant eating habits, their perception of their health, and to evaluate progress toward their healthy eating goal. Hemoglobin A1Cs and blood pressure values will also be recorded before and after the study period to quantitatively measure changes in health outcomes. Expected outcomes include improved hemoglobin A1C and blood pressure, increased fruit and vegetable consumption, and increased nutrition knowledge. This study will serve as a model for other organizations to promote healthy eating habits as a way to reduce the number of people affected by diet-related illnesses such as high blood pressure, diabetes, and obesity.
Casey Fishman, College of Arts & Sciences, 2023, Major: French
Richita Bashyal, College of Arts & Sciences, 2022, Major: Biology
Knowledge of and receptiveness to epidural labor analgesia in patients
Maternal pain and death during childbirth are all too common in light of medical technological advances of the 21st century. In lower income countries such as Rwanda. Literature generally shows the pattern that African women have one of the lowest rates of usage of pharmacological pain relief methods during labor. Some women believe that crying from the pain is a sign of weakness and therefore seeking pharmacological relief would be showing that weakness. Additionally, due to the historical lack of pain relief methods during labor, many women assume their pain is normal. Their perception of pain during labor can be influenced by a variety of social, environmental, and religious factors and the religiosity present in the Rwandan population could be a causal factor in the low usage of epidural analgesia.
A study found that 40 percent of respondents in Cameroon view epidurals as something European and 33 percent responded that it represents an unnecessary expense. This relates to African women’s views of epidural analgesia as a technology used primarily by wealthier white women. In fact, in Rwanda, historically epidural analgesia was known mostly to rich women and only available to them as it was extremely costly. However, in recent years epidurals have become more readily accessible. Despite this change in cost and therefore increased accessibility, knowledge and usage of epidural analgesia by Rwandan women is still relatively low. We hope by inquiring about their knowledge of epidural analgesics, we will pique pregnant women’s interest in learning more about and potentially taking advantage of pain relief during labor.
Magdalene Kwarteng, School of Medicine, 2025
Dontranika Maria Horton, School of Medicine, 2025
Predicting post-operative morbidity and mortality in adult surgical patients: validation of the African surgical outcomes study surgical risk calculator at Kigali University Teaching Hospital (KUTH)
The African Surgical Outcomes Study (ASOS), a major study across Africa investigating postoperative mortality, devised the ASOS Surgical Risk Calculator (ASOS SRC) to determine which patients are at higher risk of death and complications after their procedure. Assessing postoperative outcomes in individual institutions remains important as the data can be used as a tool for preoperative risk stratification for surgery. Therefore, we aim to evaluate the validity of the ASOS SCR at Kigali University Teaching Hospital (KUTH) in Rwanda.
We will conduct a prospective observational cohort study in patients undergoing elective or nonelective surgery at KUTH. An ASOS SRC score will be assessed preoperatively for each patient taking into account factors that include, but are not limited to: age, surgery indication, smoking status, and preoperative comorbidity. Postoperative outcome measures will then be collected which include critical care admission, postoperative complications, and hospital stays. Patients will then be divided into two groups: patients with ASOS SRC score < 10 and those with ASOS SRC score ≥ 10. We then will be able to compare the complication rate between the two groups using the Chi-squared test.
This comparison will allow us to assess the validity of the ASOS SRC tool for elective and non-elective surgeries in KUTH and compare our findings with that of the ASOS study.
KUTH is the largest tertiary hospital in Rwanda with many surgical patients. Determining the effectiveness of the ASOS SRC in predicting postoperative complications and mortality will allow for an increase in postoperative surveillance for patients who are at-risk for postoperative complications, as well as an overall decreased burden to health care and patients.
Emory McVeigh, School of Nursing, 2023, Masters of Science in Nursing-Clinical Nurse Leader
Bernice Fan, School of Nursing, 2023, Clinical Nurse Leader
Imani Duck, School of Nursing, 2023, Masters of Science in Nursing-Clinical Nurse Leader
Quality of sepsis management in the emergency room, and impact on mortality
The sepsis hour-1 bundle was created by the Society of Critical Care Medicine to be used as an international guideline for sepsis recognition and intervention to reduce sepsis and septic shock. The guideline includes obtaining blood cultures, administering broad spectrum antibiotics, measuring lactate, fluid resuscitation, and administering vasopressors if indicated. (Levy et al., 2018). In reviewing recent literature, we found studies in Rwanda regarding sepsis management and protocol implementation, one study conducted a comprehensive chart review to analyze the management and mortality associated with sepsis (Hopkinson et al., 2021). Another study analyzed education programs and the impact they had on the rate at which evidenced based interventions were implemented (Urayeneza et al., 2018). While these studies have added to the growing body of literature around sepsis, the need for further research continues to be present especially in Rwanda and sub-Saharan Africa. The PI of this study has asked collaborators to evaluate the compliance of sepsis guidelines on the rate of mortality in the Accident and Emergency area of CHUK. As CNL students, we have the skills to monitor adherence to published guidelines and protocols, which will subsequently identify areas of weakness needing attention. The study will determine adherence to and the efficacy of a “hour-1 bundle” protocol – an evidence based practice established to reduce mortality and complications in patients with septic shock.
Sarah Whiteside, College of Arts & Sciences, 2023, Majors: Global Public Health & Biology
Social Media Perceptions of HIV Treatment as Prevention: #UequalsU and #TasP
Treatment as Prevention (TasP) and Undetectable = Untransmittable (#UequalsU) are global advocacy campaigns aimed at raising awareness regarding the success of antiretroviral treatments (ART) in preventing the transmission of HIV. With adherence to ART, a person living with HIV (PWH) is able to achieve an undetectable viral load, and therefore remain untransmittable to their sexual partners. Altogether, the #UequalsU campaign (as well as #TasP) strives to deconstruct HIV stigma not only in the U.S., but across the globe. In fact, #UequalsU has been translated into more than 25 different languages in 79 countries. However, the campaign's reach and awareness among the general public has not been thoroughly researched. Considering Twitter’s extensive global presence, we plan to analyze all Tweet’s referencing #UequalsU and #TasP to determine public perceptions of this information since 2016. The methods of analyses employed in this study include natural language processing techniques in conjunction with unsupervised sentiment analysis and a qualitative review of sampled Tweets for thematic content. Overall, our findings may implicate the success of #UequalsU by revealing a potentially positive sentiment shift, reduction in stigma, and increase in favorable public perception over time.
Hamna Shafiq, College of Arts & Sciences, 2024, Major: Prospective Human Biology
The link between platelet activation and the altered gut microbiota of children with undernutrition/EED
Undernutrition is a major global health challenge. Inflammation, a hallmark of undernutrition is linked with dysbiosis in the gut microbiome. Our lab has shown increased expression of platelet activation genes in mice colonized with the microbiota of an undernourished child relative to mice colonized with microbiota from a healthy child. Because intestinal inflammation can drive platelet activation in other diseases, including Inflammatory Bowel Disease, we hypothesize that intestinal inflammation caused by undernutrition is also a driver of platelet activation.
This past year, I have been working in the Cowardin Lab studying the link between platelet activation and undernutrition. I will expand on our work by investigating data from human samples from the Study of Environmental Enteropathy and Malnutrition (SEEM). SEEM is a prospective cohort study that followed children in Matiari, Pakistan who were evaluated for Environmental Enteric Dysfunction (EED) and growth up to 24 months of age. EED is a syndrome characterized by reduced barrier function, absorptive capacity, and inflammation in the small intestine. RNA sequencing was performed on samples from the intestinal biopsies of the participants. I will perform a secondary analysis of these data to determine if genes related to platelet activation have elevated expression. This will inform our work at UVA by examining whether platelet activation genes identified in our mouse model are likewise increased in humans. Additionally, the SEEM study collected data on the microbiota of the participants to identify specific bacterial taxa that are present during EED. I will analyze this data to determine if members of the microbiota act as predictors of platelet activation. This project will allow me to determine if platelet activation occurs during human undernutrition/EED and investigate whether platelet is activation linked with the gut microbiome. These results can lead to the development of new therapeutic targets in children with undernutrition/EED
(Ahn) Tuyet V Chuong, College of Arts and Sciences
Evaluating and Advancing a Global Health Research Partnership Between US and Nepal
Cancer is one of the most leading causes of death in the world. This project partners with the palliative care leaders of the Nepalese Association of Palliative Care(NAPCare) and the global health researchers here at the University of Virginia to improve how palliative care and pain management is used in Nepal. Evaluating the mobile technology in Nepal helps to improve the pain system management in a country that are low in resources. This project will require a statistical data analysis to describe the data between the Nepal and UVA group. Along with this, there will be use of data tables, charts, graphs to help summarize and analyze the data from this study. Expected outcomes may show a correlation in data sets between the Nepal and UVA groups to help us better understand the partnership between the Nepal and the United States.
Ketlin Maira Palacio Smith, College of Arts & Sciences, 2024, Major: Global Public Health
ConexionesPositivas for COVID-19
It is not news that the new coronavirus (COVID-19) has changed our world. From new guidelines to the creation of new vaccines, the COVID-19 pandemic required a rapid response from Public Health leaders. More than that, the pandemic exacerbated the already established racial health disparities in the United States. The numbers show that communities of color – African Americans, Native and Americans and the Hispanic community are disproportionately affected by COVID-19. According to the Centers for Disease Control and Prevention (CDC), Hispanic/Latinx comprise 18% of the U.S. population and 28% of COVID cases, with a higher mortality rate as well. Access to healthcare and resources, poor housing conditions, economic vulnerability can be some of the social determinants that make this group more vulnerable than others to the virus. In this context, it is necessary to empower this community regarding their own health. By creating tools that possibilities self-monitoring and information support may facilitate healthcare engagement and to address social needs.