Ph.D. student Natasha Ludwig-Barron receives NIH Diversity Supplement to investigate drug injections and HIV in Kenya

As a Mexican-American, first-generation college student, University of Washington Department of Epidemiology (Epi) Ph.D. student Natasha Ludwig-Barron notes the importance of diversity supplements as a valuable resource to underrepresented students, whose backgrounds can contribute diverse perspectives to global research. Diversity Supplements are mini-grants used to support and recruit students from underrepresented racial and ethnic groups, individuals with disabilities, and individuals from economically or educationally disadvantaged backgrounds to support their careers in academic research in multiple science and health disciplines.

Ludwig-Barron received a National Institutes of Health (NIH) Diversity Supplement to assess people who inject drugs (PWID) and HIV risk in Narobi, Kenya.

1. What is the Diversity Supplement you have been awarded, and what will you be working on?

Diversity Supplements promote diversity by allowing historically under-represented students to engage in academic research, receive additional training in their field, and provides support for tuition and living expenses. The overarching goal is to create a diverse scientific workforce that can provide invaluable strategies to address scientific questions, which is particularly vital in achieving optimal population health.

The process of submitting a diversity supplement allowed me to experience first-hand what it would be like to submit a small NIH grant in the future and will allow me to experience the full lifecycle of the grant process including data collection, analysis and dissemination of findings.

I am working with Drs. Carey Farquhar [co-Pi on the project] and Josh Herbeck [co-PI on the project], who have a grant working with HIV-positive persons who inject drugs (PWID) in Nairobi, Kenya. They will be evaluating partner notification services for this specific population, which has been largely understudied and overlooked. Study sites are nested in a needle exchange program, which offers a unique opportunity to prevent the spread of infectious diseases like HIV and Hepatitis C, but can also test partners of HIV-positive PWID. Many countries have not embraced harm reduction programs, because of skepticism concerning access to needles and stigma surrounding PWID and HIV.

I conducted qualitative interviews with PWID to understand and characterize the Nairobi-specific risk environment, and I will use quantitative data to analyze risk environment factors associated with sub-optimal HIV care.  Throughout my project, I will apply the HIV care continuum and Dr. Tim Rhodes’ risk environment framework, which posits that HIV and inject drug use are not solely derived from individual behaviors, but are rather a by-product of the surrounding physical, social, political and economic environment. Similar studies have been conducted in high-income countries, but this is one of the first studies to apply the framework in Kenya. This summer, I conducted fieldwork with my research team in Nairobi at local needle exchange programs in order to set the stage for my dissertation.

2. Why is the work you’re doing through the Diversity Supplement important? How does it promote diversity? 

I think the work that I am doing is important because substance use is a global concern. Whether you live in Seattle and have experienced a friend, neighbor, family member struggling with addiction or work overseas in public health, substance use is all around us. I think this is a topic that is overlooked because people are afraid or ashamed to talk about personal issues of substance use and addiction, which has been historically portrayed as a moral issue. Today we know that issues of addiction are linked to mental health and require public health intervention.

I am committed to working with PWID, both internationally and domestically, to reduce the burden of HIV and associated co-morbidities. The contributions of the proposed Diversity Supplement will support my career development and provide important contributions to the scientific literature. By characterizing the Nairobi-specific drug risk environment and highlighting factors associated with each stage of the HIV care continuum, results of this supplement will be able to provide recommendations for future HIV programs and services that serve PWID, both nationally and globally.

The Diversity Supplement also allows me to focus on my dissertation and decide on my next steps, post-graduation. I am a Mexican-American, first-generation college student from Los Angeles, CA, where I was raised by a single mother. On my mother’s side, I am the second youngest of 26 cousins and only two of us earned a bachelor’s degree. Growing up, I did not have a network of family members or friends to consult about college, and the “ivory tower” of academia can be extremely intimidating. Diversity supplements are so important for underrepresented students because it breaks down many of the structural, economic and social barriers that prevent us from receiving a higher education.

The training goals of this Diversity Supplement build upon my graduate-level training in qualitative research methods, while improving my understanding and application of advanced statistical methods. My research training activities will consist of 9-months of in-country fieldwork, one-year of coursework in advanced qualitative methods, two-years of coursework in advanced epidemiology and biostatistics methods, applied research study planning and implementation, attending HIV and substance use seminars and workshops, and dissemination of findings through abstract preparation and manuscript development.

My deliverables will include three independent analyses, which will be submitted as three abstracts to scientific conferences and three publications to peer-reviewed journals. In addition to fulfilling milestones, I serve as research team member, attending team meetings, providing input on study-related decisions and assisting in mid-year evaluations, so that I can experience the various phases of the grant lifecycle.

3. What interests you about this work? 

Substance use is all around us and touches every income-level, age-group, gender identity, etc. On a personal level, several of my family members suffer from issues of addiction that range from alcohol abuse to injection drug use, but there are few evidence-based prevention and treatment programs that have shown to be effective and even fewer that have been tailored to minority groups.

The first time I was exposed to substance use research was 5 years, when I worked along the US-Mexico Border. My first project was working with a group of individuals whose preferred substance was methamphetamine. Like many people, I had my own bias on what I should expect working with this community. However, I quickly learned that these were teachers, construction workers, mothers, students, etc. Many discussed mental health issues and the use of meth to self-medicate, which really highlighted the need for additional interventions that approach substance use through a mental health lens. I think there is still a lot to be done in the field of substance use, which compels me to roll-up my sleeves and get to work.

4. How will this work apply to your future research? 

My post-graduation plans include pursuing a career in academia, applying mixed methods approaches to addressing issues of substance use and HIV/AIDS. Being awarded this Diversity Supplement means that I will be able to gain additional training on my research topics, receive mentorship from global health experts, and complete my doctoral degree, which seemed like an unattainable goal when I was an undergrad.

I am extremely fortunate to work with my research team who has provided mentorship and support throughout this process. I hope this is the first of many more grant awards in the future. The unfortunate part is that many underrepresented students have never heard of Diversity Supplements, despite all the benefits. My hope is that after this article is released that students will start to ask questions about Diversity Supplements with their counselors, professors and UW researchers about eligibility and application process.

5. What advice would you give students interested in applying for a Diversity Supplement?

I would say to start the process early, be very transparent to faculty about being interested in applying for a Diversity Supplement and reach out to other students that have been through the process. It can take a while to figure out which grants are eligible for Diversity Supplements; consider what your research aims will be. At the end of the day it was great experience, but I wish I would have started the process earlier. If anyone is interested in applying for Diversity Supplements, please contact John Paulson or the Epi EDI Committee to connect with other students that have been through the process.