Dr. Dorothy Dow has a Master's of Science in Global Health and will become junior faculty at Duke University Medical Center in the Division of Pediatric Infectious Diseases in July 2014. For nearly three years, she has been living and working in Moshi, Tanzania. Her long-term goal is to become an independent global health researcher integrating mental health into the prevention and treatment of HIV among adolescents. During HIV clinic both at Duke University and Kilimanjaro Christian Medical Centre (KCMC), Dr. Dow has come to realize the reality of the statement, no health without mental health. Her preliminary research evaluating the prevalence of mental health difficulties among HIV-positive adolescents in Tanzania has demonstrated symptoms of depression and trauma are prevalent in the local HIV youth clinic. Despite these findings, there are no psychologists or psychiatrists currently available at KCMC. This proposed career development plan incorporates a multidisciplinary five-year program complete with didactic training in global mental health, research methods and trial design, advanced biostatistics, and management skills for implementing large clinical trials. These didactics closely align with a mentored, patient-oriented research experience designing, adapting, and implementing a mental health intervention in the HIV adolescent clinic. Dr. Dow will receive mentorship from Dr. Coleen Cunningham (Chief, Pediatric Infectious Diseases and Pediatric Global Health), Dr. Karen O'Donnell (Clinical Psychology), Dr. Kathryn Whetten (Director of the Center for Health Policy and Inequalities Research), Dr. Blandina Mmbaga (Co-Site leader KCMC-Duke Collaboration, Professor of Pediatrics), and consultants Dr. John Bartlett (Duke Global Health Institute, DGHI) and Dr. Kathleen Sikkema (Clinical Psychology). Dr. Dow proposes to integrate both a HIV educational curriculum and an intensive cognitive behavioral therapy (CBT) and life skills training program called SPARCS, into the HIV teen clinic.
The first aim i s to create a tool kit by adapting both a HIV educational curriculum and SPARCS to be culturally relevant and in Swahili language.
The second aim i s a feasibility study to determine if SPARCS improves mental health, adherence, and viral outcomes. Based on the work of Dr. Dow's mentors who have successfully implemented trauma-focused CBT among orphans in Tanzania, it is anticipated that SPARCS will also be feasible to implement in a resource-limited setting. The hypothesis is that by addressing mental health needs, youth will demonstrate improved ART adherence and improved virologic outcomes. This project is anticipated to improve both mental and physical health of HIV-positive adolescents in Tanzania and open a dialogue of discussion around mental health difficulties in this setting. Upon completion of this feasibility study and further didactics and mentorship, the candidate plans to submit a R01 grant to evaluate the efficacy of this intervention as a randomized controlled trial, fulfilling her goal of conducting independent global health research to improve the overall health of adolescents living in Tanzania and other resource-limited settings.

Public Health Relevance

This project aims to address the mental health treatment gap that exists in the HIV youth clinic in Moshi, Tanzania with the goal of improving adherence to antiretroviral therapy (ART) and HIV outcomes. Addressing this treatment gap is highly relevant in two important ways. First, improved ART adherence is important not only for one's own health, but as these youth become sexually active, it also decreases the risk of sexual transmission of HIV to their partners. Second, as perinatally HIV-infected children age into adolescence, their mental health difficulties and traumatic experiences must be addressed to facilitate a healthy and productive adulthood.

Agency
National Institute of Health (NIH)
Institute
Fogarty International Center (FIC)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01TW009985-03
Application #
9294863
Study Section
International and Cooperative Projects - 1 Study Section (ICP1)
Program Officer
Bansal, Geetha Parthasarathy
Project Start
2015-07-01
Project End
2020-06-30
Budget Start
2017-07-01
Budget End
2018-06-30
Support Year
3
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Duke University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Tabb, Zachary J; Mmbaga, Blandina T; Gandhi, Monica et al. (2018) Antiretroviral drug concentrations in hair are associated with virologic outcomes among young people living with HIV in Tanzania. AIDS 32:1115-1123
Gichane, Margaret W; Sullivan, Kristen A; Shayo, Aisa M et al. (2018) Caregiver role in HIV medication adherence among HIV-infected orphans in Tanzania. AIDS Care 30:701-705
Ramos, Julia V; Mmbaga, Blandina T; Turner, Elizabeth L et al. (2018) Modality of Primary HIV Disclosure and Association with Mental Health, Stigma, and Antiretroviral Therapy Adherence in Tanzanian Youth Living with HIV. AIDS Patient Care STDS 32:31-37
Dow, Dorothy E; Schimana, Werner; Nyombi, Balthazar M et al. (2017) HIV Resistance and Prevention of Mother-to-Child Transmission Regimen in HIV-Infected Infants in Northern Tanzania. AIDS Res Hum Retroviruses 33:1107-1113
Boerma, Ragna S; Bunupuradah, Torsak; Dow, Dorothy et al. (2017) Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure. J Int AIDS Soc 20:21930
Dahinten, Alexander P; Dow, Dorothy E; Cunningham, Coleen K et al. (2016) Providing Safe and Effective Preventative Antiretroviral Prophylaxis to HIV-exposed Newborns via a Novel Drug Delivery System in Tanzania. Pediatr Infect Dis J 35:987-91
Ramaiya, Megan K; Sullivan, Kristen A; O' Donnell, Karen et al. (2016) A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania. PLoS One 11:e0165936
Dow, Dorothy E; Turner, Elizabeth L; Shayo, Aisa M et al. (2016) Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania. AIDS Care 28:825-33
Dow, Dorothy E; Bartlett, John A (2014) Dolutegravir, the Second-Generation of Integrase Strand Transfer Inhibitors (INSTIs) for the Treatment of HIV. Infect Dis Ther 3:83-102
O'Donnell, Karen; Yao, Jia; Ostermann, Jan et al. (2014) Low rates of child testing for HIV persist in a high-risk area of East Africa. AIDS Care 26:326-31

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