Out of only 16 recipients, four University of Washington (UW) Department of Epidemiology (Epi) students were selected as TL1 Translational Research Training Program trainees at the Institute of Translational Health Sciences (ITHS). The UW program brings together a multi-disciplinary group of predoctoral students interested in a career in translational science.
The year-long program offers a combination of thoughtful mentorship, interdisciplinary interaction and focused training, presenting trainees with the career development tools needed to become impactful translational researchers.
Epi Ph.D. students Tigran Avoundjian, Rachel Kubiak, Vivian Lyons and Kathryn Peebles were admitted to the training program for their diverse and impactful research projects, outlined below.
Project: “Improving HIV care engagement through the use of real-time health information exchange between health departments and emergency departments”
Project Description: The goal of the research project is to evaluate whether the use of real time health information exchange (HIE) between UW Medicine and the Public Health Seattle (PHSKC) King County HIV/STD program has improved HIV care engagement among poorly engaged persons living with HIV (PLWH) who present to the ED or are admitted to the hospital. The PHKSC-UW HIE Data to Care program will send a text message notification to health department staff when an out-of-care PLWH is seen at a UW Medicine emergency department or inpatient facility. Health department staff members who specialize in assisting patients with re-engaging in HIV care attempt to contact the patient while they are still in the ED or inpatient facility or soon after they are discharged to assist them with relinking back to HIV care. The research will be using a mixed methods approach to evaluate this project. First, the research will quantitatively assess the impact this information exchange has had on HIV care engagement and viral suppression using retrospective electronic medical record and HIV surveillance data. In addition, the research will qualitatively describe the work and information flows of the PHSKC-UW Medicine HIE Data to Care program through semi-structured interviews with health department staff and identify the program's key facilitators and barriers.
In his own words: “One of my major career goals is to improve the health and quality of life of vulnerable populations through the integration of epidemiology and informatics. Leveraging the growing wealth of massive repositories of public health surveillance and health care big data is crucial to improving the effectiveness and efficiency of public health prevention efforts and informing health promotion, treatment guidelines, and policy. In addition, I have always been interested in HIV epidemiology and prevention. In particular, I am interested in population subgroups that "fall through the cracks" of the HIV care continuum (i.e., the process from HIV diagnosis to treatment to viral suppression), the reasons for these gaps, and new strategies to address them. This project was a perfect opportunity for me to bring together all of these interests!”
Project: “Diabetes prevalence and impact on treatment outcomes in an urban HIV-infected South African cohort”
Project Description: The goal of this project is to understand more about the epidemiology of diabetes in a region with high burdens of HIV and tuberculosis (TB), and to estimate the relationship of diabetes with poor health outcomes in the context of HIV infection. The research will leverage clinical data collected as part of an ongoing prospective cohort study of newly diagnosed HIV-infected adults in KwaZulu-Natal, South Africa who are followed for one year. The research aims to determine the prevalence of diabetes and characterize the diabetic population in terms of clinical and demographic measures, focusing on those that are easy to obtain. The research will use multivariable regression models to estimate the associations of diabetes with key HIV treatment outcomes. It will use a generalized linear model to calculate the TB period prevalence difference among participants with diabetes versus normoglycemia and fit a Cox proportional hazard model to generate a hazard ratio for death by diabetes status. In the long run, evaluation of the burden of diabetes, the relationships between these diseases and outcomes could guide the integration of diabetes care with the existing HIV/TB clinical care model to reduce morbidity and mortality.
In her own words: “I became interested in the intersection of infectious and non-communicable diseases within the unique context of resource-limited settings through working at the Boston University TB Clinical Diagnostics Research Consortium and the UW Kidney Research Institute. TB, HIV, and diabetes are important sources of morbidity and mortality globally, and are increasingly co-prevalent as low- and middle-income countries industrialize. I’m motivated to engage in this emerging field of research because there is a lack of basic epidemiologic data and a growing need to understand disease dynamics in order to develop cost-effective screening strategies and treatment interventions.”
Project: “Subsequent Injury Among Gunshot Wound Patients”
Project Description: The project is nested within an ongoing pragmatic randomized controlled trial (Helping Individuals with Firearm Injuries [HiFi]) of a novel intervention designed to promote the health and well-being of gunshot wound (GSW) patients. Prior evidence has shown that GSW is associated with high risk of both perpetration of crime and subsequent injury after hospital discharge. The main outcome of interest in HiFi is arrest. The research will evaluate the effect of the HiFi intervention on reducing the rate of subsequent injury after hospital discharge using emergency department data and survival analyses for both time to first and time to recurrent injury. This is a critical outcome to study since lowering its rate can lead to reductions in the high cost of injury care, loss of work and potential need for acute and long-term care. The research will also conduct a cost-utility analysis of the HiFi intervention program to capture the cost of the intervention on quality-adjusted life years from subsequent injury. As part of this analysis, the research will propose cost-saving approaches to large-scale implementation of the HiFi intervention program.
In her own words: “My interest in injury prevention research began when I was working as an Advocate for a Domestic Violence Agency. I was shocked by how many people experience some form of injury or violence in their lives, and how that injury can impact the rest of their lives. I was drawn to the HiFi study specifically because I felt it had tremendous translational impact.”
Project: “Sources of efficacy dilution in the clinical trial and implementation of a dapivirine-containing vaginal ring for HIV-1 prevention: Insights from mathematical models”
Project Description: In sub-Saharan Africa, women are at disproportionate risk for HIV acquisition, and prevention methods that are discrete and female-controlled are needed to address women’s prevention needs. While intravaginal HIV pre-exposure prophylaxis (PrEP) methods have been less efficacious in clinical trials than orally administered PrEP, this relatively lower efficacy may be due to multiple sources of efficacy dilution to which orally administered PrEP is less subject. This project will therefore evaluate the relative contribution of potential sources of efficacy dilution, including product non-adherence and heterosexual anal intercourse, in the clinical trial and implementation of a vaginal ring for HIV prevention. The project will use a mathematical microsimulation model that replicates the study population and protocol of the ASPIRE trial to 1) infer anal intercourse parameters through an approximate Bayesian computation model-fitting procedure and 2) conduct as-observed and counterfactual simulations to estimate the relative contribution to vaginal ring efficacy dilution of product non-adherence and anal intercourse in the ASPIRE trial. The project will use these estimates in a population-level model of HIV transmission dynamics in Kenya to estimate the impact of both sources of efficacy dilution on HIV prevention effectiveness of the ring in an implementation context. The results of these analyses will inform the suitability of a vaginal ring PrEP formulation to reduce HIV incidence among the priority population of young women in Kenya.
In her own words: “I first became interested in HIV research while completing a summer practicum at the Center for Infectious Disease Research in Zambia. Through my work and experiences there, I came to understand the immense burden that HIV continues to place on populations in sub-Saharan Africa, and was motivated to pursue HIV research in my PhD program. I’ve been drawn to the power of mathematical models to inform population-level impact and cost-effectiveness of HIV prevention interventions, and thereby aid decision- and policy-makers in assessing the relative value of intervention implementation in the context of limited resources.”