Global Health

Letter from the Chief

The Division of Global Health at Mass General for Children was founded in 2010 and includes faculty, research fellows and staff with diverse experience and interests but a shared objective. Our goal is to build and foster strong partnerships for interdisciplinary research, education and clinical care aimed at improving the health of the most vulnerable children in our global community. Our work builds not only upon Mass General for Children’s long-standing commitment to scientific and clinical innovation, but also on our strong desire to see every child reach their full potential.

Our teams work on the most important challenges in pediatric global health. We focus on:

1. Conducting world-class research that improves the availability of evidence-based healthcare for children, finding answers to important questions which are needed to shape health policies.
2. Helping to train global health clinicians through educational opportunities and collaboration
3. Building multifaceted international partnerships that foster sustainable action and impact

Our faculty and staff work on innovative solutions to prematurity, birth asphyxia, neonatal sepsis, childhood pneumonia, cholera transmission, and HIV at several sites across the globe. Each day, we strive to apply the strengths of the Mass General community to help the most vulnerable children in our global community.

Sincerely,

Jason B. Harris, MD, MPH
Division Chief, Pediatric Global Health
Associate Professor of Pediatrics
Harvard Medical School
Pediatric Infectious Diseases, Microbiology

Research Projects

Assessing Measures to Eliminate Cholera Transmission in Haiti – Dr. Jason Harris

This study is designed to assess the effectiveness and impact of integrated programs to control cholera combining community level oral cholera vaccination with the promotion of household water treatment strategies. The study not only evaluates the impact of these measures on the incidence of Vibrio cholerae infection, but also assesses the potential impact of these programs on other important health measures during early childhood. The project involves an ongoing close collaboration between Mass General and Partners In Health/ Zanmi Lasante in Central Haiti.

B Cell Responses to V. cholerae and Protection Against Cholera – Dr. Jason Harris

This study is designed to unravel the key mechanisms of protective antibody responses (following both vaccination and infection) against Vibrio cholerae infection in humans. The research involves a longstanding collaboration between Mass General and the icddr,b (the International Centre for Diarrhoeal Disease Research, Bangladesh).

'Bubble CPAP’: an Ultra-Low-Cost Device for Reducing Newborn and Child Mortality from Respiratory Diseases- Dr. Brett Nelson

Respiratory illnesses are a leading cause of newborn and child mortality. The vast majority of these deaths globally occur in low-resource settings. To prevent a large number of these respiratory-related newborn deaths, we have developed an innovative, low-cost, best-evidence bundle that includes an innovative 'bubble CPAP' device — which assists the child in breathing — along with clinical checklists, training, training materials, and wallcharts. Our early results in multiple hospitals in Kenya and India suggest our bundle can greatly reduce child morbidity and mortality from respiratory diseases worldwide. We hope to now build upon this pilot work, expand to additional health facilities, and gather reliable evidence of our device's lifesaving potential.

Diagnosing and Preventing HIV Infection in Adolescents and Young Adults in the US: Clinical Impact and Cost-Effectiveness- Dr. Anne Neilan

Dr. Anne Neilan is supported by an NICHD K08 Award to use computer simulation modeling methods and cost-effectiveness analysis to evaluate current questions in HIV prevention and screening in US adolescents and young adults at risk of HIV.

Investing in the HIV Care Continuum: Model-Based Methods to Translate ATN Findings into Policy Recommendations- Dr. Anne Neilan

Dr. Neilan is the assistant director of the Modeling Core for the Adolescent Medicine Trials Network for HIV AIDS Intervention (ATN 161). The ATN Modeling Core uses data already collected through completed studies and ongoing ATN protocols to inform critical health policy recommendations for youth living with HIV.

Early and Novel Treatment of HIV-infected Infants and Children

Neonatal HIV-1 infection and concurrent immune system development may offer unique opportunities for understanding HIV viral reservoir establishment and identify HIV eradication strategies. Dr. Kate Powis is a co-Investigator on two NIH funded studies in Botswana (U01AI114235, U01AI135940; Principal Investigator: Shapiro) exploring the efficacy and safety of early initiation of antiretroviral treatment (ART) among infants found to be HIV-infected at birth, and trialing exclusive use of broadly neutralizing antibodies as a treatment strategy for HIV-infected children on virally suppressive ART regimens from birth. Quantifying HIV viral reservoirs and change in the reservoirs over time among infants and children participating in these studies will inform the HIV cure agenda.

Addressing the Health of HIV-Exposed Uninfected Children Globally

Ensuring that pregnant and breastfeeding women living with HIV have access to antiretroviral treatment (ART) has resulted in over 60% reduction in HIV-acquisition among infants from 490,000 in 2000 to 180,000 in 2017. Yet, the number of women living with HIV who experience pregnancy annually has remained constant, at over 1.4 million per year. This has resulted in more than 1 million infants born annually with in utero exposure to HIV, and an increasing number also exposed to antiretrovirals (ARVs) in utero. While the vast majority of HIV- and ARV-exposed infants remain HIV-uninfected, they are HIV-affected. HIV/ARV-exposed uninfected (HAEU) infants are more likely to be born preterm and small-for-gestational age compared to infants born to HIV-uninfected women. Additionally, HAEU children experience 2-fold higher morbidity and mortality compared to HIV-unexposed uninfected (HUU) children, poorer growth and neurocognitive delays. In the maturing HIV epidemic, focus has shifted to finding the safest ARVs for using in pregnancy and breastfeeding to ensure that HIV-exposed infants remain uninfected and thrive.

Dr. Powis is the Principal Investigator of an NIH funded project (R21 HD093531) to harmonize HAEU exposure and outcome data collected by researchers and within health care systems globally. This project will provide flexible data collection tools for researchers and governments and uptake will achieve data harmonization. Ultimately, the project will enable comparison of HAEU child exposures and outcomes in key domains, such as birth outcomes, morbidity/mortality, and neurodevelopment, between research cohorts and national health systems data. Additionally, the project is structured to accommodate data pooling by participating researchers and governments. Pooling of data will permit identification of subtle disparities that may not have individual clinical consequences, but impact population level human capital. Dr. Powis has secured the support of the World health Organization, UNICEF and other experts in child health to carry out this project.

Training Opportunities

Pediatric “Longitudinal Elective in Global Health” (LEiGH)

The Division has established a rigorous pediatric global health curriculum that provides residents an essential understanding of how to deliver effective clinical care in resource-poor settings and unique clinical needs of immigrant families for whom residents provide care in their continuity outpatient clinics. Energetic faculty members collaborate to provide expert resident training in global health through engaging presentations interspersed in the resident longitudinal curriculum and mentoring residents in global health clinical elective experiences. Topics include global burden of disease, child nutrition, newborn and maternal-child health, and infectious diseases, global health professionalism, and practical skills that you “must know before you go” on an international elective.

Residents have the opportunity to work globally during Global Health Clinical Electives in safe, mentored, and educational environments. Our residents have worked at well-developed sites in Botswana, Uganda and Mexico. Some residents have opted to coordinate their own elective sites, with vetting and approval from the Division of Pediatric Global Health. These have included Tanzania, Guatemala, Haiti and Geneva. Our residents benefit from the expertise of a diverse faculty working in a multitude of international settings who are eager to serve as mentors to the next generation of leaders in pediatric global health.

“Clinical Topics in Global Health,” a Global Health and Tropical Medicine Course at Harvard Medical School

This global health course, co-directed by Brett D. Nelson, MD, MPH, DTM&H, and Peter Moschovis, MD, is a novel clinical skills-based curriculum established for Harvard medical students and residents with the primary objective of providing participants with essential clinical knowledge and skills to work effectively in resource-limited settings. The course consists of 10 evening sessions taught by a multidisciplinary faculty, with curriculum focused on the practical management of the leading causes of mortality and morbidity in low- and middle-income countries.

Currently there are three overseas sites where Mass General for Children residents can participate in mentored clinical electives:

Botswana

Botswana is a land-locked middle-income country located in southern Africa, and bounded by South Africa to the south, Zambia to the north, Zimbabwe to the east and Namibia to the west. The population is slightly greater than 2 million people. Formerly a British Protectorate, in 1966 Botswana gained its independence and has had a democratic and stable political system. In 1967, large quantities of diamonds were discovered. The gross domestic product of the country relies on the diamond and tourism sectors predominantly.

Botswana has the second highest prevalence of HIV among adults aged 15 to 49. The HIV epidemic in Botswana led to support from the United States government in the form of the President’s Emergency Plan for AIDS Relief (PEPFAR) initiated by President Bush. PEPFAR funding continues to support activities to control Botswana’s HIV epidemic. In late 1990s, Professor Max Essex of the Harvard T.H. Chan School of Public Health met with President Fetus Mogae and formed the Botswana-Harvard AID Institute Partnership (BHP), a collaboration between the Botswana government and Harvard School of Public Health to build laboratory capacity within the country to manage the HIV epidemic. This organization is one of the country’s national lab sites for HIV viral load testing. Activities have expanded to research, public health policy, and clinical education. In 2009, a partnership between BHP and Scottish Livingstone Hospital (SLH) was created to improve the overall quality of hospital care and provide a training site for Boston area residents. Scottish Livingstone is a district hospital with 350 beds and substantial outpatient services.

This clinical site accepts pediatric and med-peds residents to work on inpatient pediatrics and adult medicine wards, the outpatient pediatric HIV clinic, and outpatient adult medicine, accident and emergency centers. There are opportunities to engage in a quality improvement project selected from a list of initiatives deemed to be important to the hospital’s management team. The contact person for this site is Dr. Kate Powis.

Chiapas, Mexico

Please contact Kate Powis with questions regarding this site.

Mbarara, Uganda

Sub-Saharan Africa faces a most daunting challenge: it bears 25 percent of the global burden of disease but has only 3 percent of the world’s health workers. With a population of 37 million, Uganda is one of Africa's largest and fastest-growing countries. Despite rapid economic growth realized in the past decade, many Ugandans still live in poverty and confront several social and economic inequities: 65 percent of its population lives on less than US$2 per day. Training and retention of professional health staff is a serious problem, and Uganda is no exception. Under the auspices of the Mass General Center for Global Health, Mass General has developed a multidisciplinary collaborative relationship with Mbarara University of Science and Technology (MUST) and Mbarara Regional Referral Hospital (MRRH), as well as with the health center at Bugoye, a level III rural health center serving 35,000 people located approximately three hours by car northwest of Mbarara. Residents from the Mass General departments of Pediatrics, Medicine, Surgery, OB-GYN, Anesthesia, and others regularly visit MUST to collaborate on research and education. Additionally, the Bugoye Health Center is a primary training site for residents in the Mass General Global Primary Care Program.

Faculty in the Department of Pediatrics at MRRH, in the Mass General Center for Global Health, and in the Division of Pediatric Global Health at Mass General for Children are engaged in a diverse focus of research, including malaria, TB, pneumonia, HIV, and neonatal resuscitation. A collaborative initiative is presently underway to develop a regional oncology center at MRRH, with support from the Mass General Cancer Center and the Uganda National Cancer Institute.

At the Mbarara Regional Referral Hospital (MRRH), Mass General pediatric residents have the opportunity to work alongside Ugandan pediatricians and trainees from the Mbarara University of Science and Technology (MUST) to provide inpatient and outpatient care and to develop educational initiatives in a resource-constrained setting. Mass General pediatric faculty are currently active in research projects and medical education at MUST, and provide close mentorship and support for pediatric resident who chose to train at this site. The contact person for this site is Dr. Kate Powis.