During the 10-week training period, LEAD trainees will work remotely to gain hands-on research experience, taking advantage of the opportunities offered by three NIMH funded U19 level global research hubs across multiple Sub-Saharan African countries. The projects listed represent examples of studies on which LEAD trainees may work, and are subject to change.

Ghana

SITE: SMART Africa – Ghana

This longitudinal experimental pilot study is conducted in three primary public schools in the Northern Region in Ghana. Each school is randomly assigned to one of three study conditions: 1) Multiple family group (MFGs) delivered by parent peers; 2) MFG delivered by School Health Education Program (SHEP) coordinators; or 3) comparison: usual care comprised of mental health materials, bolstered with school materials. The study will recruit a total of 180 children (ages 8 to 13 years) and their caregivers, four parent peers, and four SHEPs.

Mentors:

Emmanuel Asampong, PhD
SMART Africa Co-Principal Investigator
Senior Lecturer, School of Public Health, University of Ghana

Alice Boateng, PhD
Senior Lecturer, Department of Social Work
University of Ghana

Peter Yaro
Executive Director
Basic Needs-Ghana

SITE: HIV Cure Research Infrastructure Study (H-CRIS) – Ghana

HIV continues to be a major public health problem in Africa. Although combination antiretroviral therapy (cART) has reduced mortality and improved lifespan, it does not provide cure. Patients must take medications daily for the rest of their lives with side effects, unsustainable costs, and development of resistance. Here, we propose to screen an epigenetic library of compounds, select the most effective and evaluate them in resting T cells isolated from HIV patients on cART. To do this, we will follow a cohort of patients, measure their viral loads and select those who have virologic suppression for the reactivation studies. This study will provide useful information on virologic suppression among Ghanaian patients, effectiveness of current therapy and discover novel compounds for the ‘shock and kill’ approach to HIV cure.

Objectives:

  1. To fully characterize a cohort of HIV patients and evaluate their knowledge and attitude towards participation in HIV cure research.
  2. To screen a panel of 150 epigenetic modifying compounds for ability to reactivate HIV from latency in a cell line and primary cell model of latency.
  3. To evaluate top 10 lead compounds in resting CD4 T cells isolated from patients suppressed on cART for more than 6 months
  4. To assemble a well-characterized HIV patient’s biobank to serve as a repository of samples for future research and student training.

Mentors:

George B. Kyei, MD, PhD
Assistant Professor of Medicine Washington University in St. Louis
Senior Research Fellow, Noguchi Memorial Institute for Medical Research, University of Ghana

Dzifa Attah, PhD
Clinical Psychologist
Lecturer in Psychiatry
University of Ghana

Angela Ofori-Atta, PhD
Clinical Pschologist
Associate Professor of Psychiatry
University of Ghana

Peter Puplampu, MB, ChB (MD)
Fellow, West Africa College of Physicians
Lecturer in Medicine
University of Ghana

Kenya

Site: SMART Africa – Kenya

This longitudinal experimental pilot study is conducted in three public primary schools located in Kiambu County, Kenya. Each school is randomly assigned to one of three study conditions: 1) MFG (multiple family group) delivered by parent peers; 2) MFG delivered by CHWs (community health workers); or 3) comparison: usual care comprised of mental health materials, bolstered with school materials. The study will recruit 180 children (ages 8 to 13 years) and their caregivers, four parent peers, and four CHWs.

Mentors:

Manasi Kumar, PhD
Senior Lecturer, Department of Psychiatry
University of Nairobi

Muthoni Mathai, PhD
SMART Africa Co-Investigator
Psychiatrist and Senior Lecturer, Department of Psychiatry
University of Nairobi

Anne W. Mbwayo, PhD
SMART Africa In-Country Principal Investigator
Lecturer and Clinical Psychologist, Department of Psychiatry
University of Nairobi

Site: HIV Implementation Research

This study aims to enhance engagement in HIV care and treatment in Kisumu, Kenya. With a focus on addressing mental health as a critical component for HIV care engagement. It is funded by NIMH and the Gates Foundation.

Mentor:

Elvin Geng, PhD
Professor, School of Medicine
Director, Center for Dissemination and Implementation Science
Washington University in St. Louis

Site: An Adaptive Strategy for Preventing and Treating Lapses of Retention in HIV Care for Adolescents (A4A)

Adolescents and young adults (AYA) aged 14-24 years with HIV in Africa experience substantially higher rates of viral failure and HIV-related mortality as compared to adults. Our study seeks to improve HIV treatment outcomes among adolescents and young adults in low-resource settings in Kisumu, Kenya, through evaluating six adaptive strategies for engagement using a sequential multiple assignment randomized trial (SMART) design. This study seeks to assess how to best combine, over time, individual engagement interventions to achieve the greatest public health impact for AYA in Africa as well as how the strategies work through mixed methods approaches. Aim 1: Assess the effectiveness of standard of care routine education and counseling vs. electronic navigation for preventing lapses in engagement among 880 AYA living with HIV in Kenya (Stage 1). Aim 2: Assess the effectiveness of standard of care outreach and intensified counseling, a conditional cash transfer or an in-person peer navigator to re-engage AYA after lapse in engagement (Stage 2). Aim 3: Assess the effectiveness and cost effectiveness of six strategies for engagement of AYA based on combinations of two Stage 1 interventions (standard of care routine education and counseling vs electronic navigation) with three Stage 2 interventions (standard of care outreach and intensified counseling, conditional cash transfer, in-person peer navigation) on retention and viral load over 24 months. Poor retention (loss to follow-up is 2-3 fold higher in AYA than adults) and adherence among AYA result from a wide range of structural (e.g., lack of money for transportation), clinic-based (e.g., lack of youth-friendly services), and psychosocial (e.g., depression, desire for peer acceptance, stigma) barriers encountered disproportionately by AYA. Our Stage 1 intervention, electronic navigation, and the Stage 2 intervention in-person navigation, will work to address multiple barriers, including mental health and well-being.

Mentor:

Elvin Geng, PhD
Professor, School of Medicine
Director, Center for Dissemination and Implementation Science
Washington University in St. Louis

Rwanda

Site: Sugira Muryango: Longitudinal Follow-up of Families from a Cluster Randomized Trial

We aim to expand the evidence base for Sugira Muryango by undertaking a multi-year longitudinal study to assess sustainment of intervention effects and long-term program effects on novel school readiness outcomes (e.g. transition to formal schooling), including measures of physical growth and cognitive development. Moreover, we will prioritize an examination of sex differences, which were not previously observed, but may emerge over time and become critical as children enter formal schooling. First, we will be able to investigate long-term impact of Sugira Muryango on early childhood development (ECD) outcomes and parental behaviors while understanding “what it takes” to track and follow-up families in rural Rwandan villages 3 years after participating in Sugira Muryango.

Mentors:

Theresa Betancourt, ScD
Salem Professor in Global Practice
School of Social Work, Boston College
Director, Research Program on Children and Adversity (RPCA)

Sarah Jensen, PhD
Research Scientist
School of Social Work, Boston College

Sierra Leone

Site: Ebola Virus Disease Pediatric Mental Health Study (EVD-PMH)

The unprecedented 2013-2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined.  Among the more than 28,000 people infected with EVD approximately 21% were children under the age of 16. Countless more children were affected by this virus as greater than 16,000 lost one or both parents during the outbreak. Prior research on chronic infectious diseases such as HIV has demonstrated lasting health, social and psychosocial outcomes. Yet, little is known about the long-term complications of EVD, or more generally, mental health complications related to acute infectious disease outbreaks. Our multidisciplinary research team is well positioned to answer these questions, and includes experts in EVD care, infectious disease clinical research, pediatrics, psychiatry, child development, and behavioral sciences. This collaboration of US-based and local investigators will access EVD survivors and children affected by EVD in Sierra Leone, one of the countries hardest hit by the outbreak.

Mentor:

Thomas Crea, PhD
Professor
School of Social Work, Boston College

SITE: Youth Forward Hub – Sierra Leone

Youth FORWARD establishes partnerships that leverage the expertise and resources of the Boston College School of Public Health, University of Georgia College of Public Health, CARITAS, World Bank, the government of Sierra Leone, and a network of youth service providers and universities.

This Scale-Up Study uses a hybrid implementation- effectiveness trial design across N=24 youth employment programs to evaluate an innovative approach to training and supervision—Interagency Collaborative Teams —and their influence on integration, fidelity, cost and sustainment of a quality mental health intervention—the Youth Readiness Intervention (YRI)—into a national youth employment program—the Youth Employment Scheme. The concurrent effectiveness trial will assess youth mental health, emotion regulation, functioning and economic self-sufficiency among N=960 Sierra Leonean male and female youth aged 15-24 over time to determine effects of the YRI when implemented under this new delivery platform. Guided by the EPIS implementation model, qualitative data on attitudes towards mental health and barriers and facilitators to the integration of mental health services into youth employment programs will be collected.

Mentor:

Theresa Betancourt, ScD
Salem Professor in Global Practice
School of Social Work, Boston College
Director, Research Program on Children and Adversity (RPCA)

South Africa

Site: S-MHINT

S-MHINT is a research and capacity building consortium in Southern Africa that aims to strengthen regional mental health integration into primary health, antenatal, and chronic care platforms using implementation science in under-resourced areas of eastern South Africa. S-MHINT has the following overall aims:

  1. To establish and engage a trans- disciplinary Research consortium of academics, government representatives, non-governmental organizations in South Africa to address the burden of common mental disorders in primary Health care settings;
  2. To examine multi-level influences on the uptake, implementation, effectiveness and sustainability of an existing scale up of an integrated Mental health package for chronic disorders at primary Health care level in two different districts having different resource capacities in South Africa;
  3. To build implementation science and dissemination Research capacity in South Africa, recruiting service providers, managers, and policy makers as trainees, providing real world opportunities, mentorship, and necessary knowledge to conduct optimal scale-up of evidence-based integrated Mental Health care.

Mentors:

Arvin Bhana, PhD
Chief Specialist Scientist at the South African Medical Research Council
Honorary Associate Professor of Psychology
University of KwaZulu-Natal Durban

Inge Petersen, PhD
Professor, School of Applied Human Sciences
Honorary Associate Professor of Psychology
University of KwaZulu-Natal Durban

Uganda

Site: SMART Africa – Uganda

This longitudinal experimental study is conducted in the Greater Masaka region. Thirty primary public schools are randomly assigned to one of three study conditions: 1) multiple family group (MFG) delivered by parent peers; 2) MFG delivered by community health workers (CHWs); or 3) comparison: usual care comprised of mental health materials, bolstered with school materials. The study has recruited a total of 2,758 children (ages 8 to 13 years) and their caregivers, 60 parent peers, and 60 CHWs.

Mentors:

Apollo Kivumbi, MBChB, MPH
SMART Africa-Uganda In-Country Principal Investigator

James Mugisha, PhD
Senior Lecturer
Kyambogo University

Fred Ssewamala, PhD
Co-Director, LEAD Training Program
William E. Gordon Distinguished Professor
Associate Dean for Transdisciplinary Faculty Research
Professor of Medicine, School of Medicine
Washington University in St. Louis

Site: Effectiveness and Implementation of an Early Childhood School-Based Mental Health Intervention in Low-Resource Communities

To test a school-based task-shifting model of mental health preventive intervention (ParentCorps-Professional Development), using two implementation approaches (with and without strategies to overcome community health workers’ stress) and site varied scalable approaches, to promote child population mental health in Ugandan urban and rural schools.

Mentors:

Keng-Yen Huang, PhD
Associate Professor, Department of Population Health
School of Medicine, New York University

Janet Nakigudde, PhD
Behavioral Science Lecturer/Clinical Psychologist
Collage of Health Sciences, Makerere University

United States

Site: Leveraging social media and technology to bridge the mental health treatment gap

With funding from NIH and SAMHSA, Dr. Cavazos’ research portfolio is at the cutting edge of research into the use of social media and digital technology to combat barriers to addiction and mental health treatment.

Mentor:

Patricia Cavazos-Rehg, PhD
Co-Director, LEAD Training Program
Professor of Psychiatry, School of Medicine
Vice Chair for Diversity, Equity and Inclusion in the Department of Psychiatry
Washington University in St. Louis

Multiple Sites

Site: Improving women’s safety and well-being in low-income and humanitarian settings: Evaluating Women’s Collectives and Information Management Systems

This project is part of an ongoing partnership with UNICEF aimed at understanding and addressing the safety and wellbeing of women and girls in low-income and humanitarian settings. Current activities include an evaluation of the new Gender-Based Violence Information Management System+ (GBVIMS+) in South Sudan and Jordan as well as building on earlier work exploring the role of Women’s Collectives in promoting women’s wellbeing and freedom from violence in humanitarian settings. A more detailed description of project activities will be provided as the scope of the work is solidified.

Mentors:

Ilana Seff, DrPH
Research Assistant Professor
Brown School
Washington University in St. Louis

Lindsay Stark, DrPH
Associate Professor
Associate Dean for Global Strategy and Programs
Brown School, Washington University in St. Louis

Site: Enhancing Capacity for Mental Health Research and Care in Cambodia

The agrarian political regime of the Khmer Rouge in Cambodia led to the death of nearly 2 million civilians and residual symptoms of distress among many survivors. Recent estimates indicate that nearly 50% of the general population exhibits clinically significant symptoms of trauma-related anxiety and/or depression. Targeting of academic leaders during the genocide further undermined an already vulnerable academic health system needed to support innovations in mental health research and care. Specific Aim 1 will strengthen the mental health research capacity across performance sites utilizing a combination of standardized content for global mental health and professional development programs tailored for research in Cambodia. Specific Aim 2 will examine the acceptability and feasibility of trauma-informed care as a culturally relevant response to trauma exposure. Specific Aim 3 will determine the effectiveness of a culturally-informed, EBT to reduce symptoms of trauma- related anxiety, depression, and problematic substance use. Preliminary work suggests that the Common Elements Treatment Approach (CETA), a task-sharing EBT has high potential to improve affective disorders and substance use disorders in resource restricted environments. However, studies have only examined CETA administered with ongoing supervision by US-based clinicians. Scale-up and sustainability of CETA in resource restricted environments requires empirical evidence that CETA is effective when administered by providers working in the local health system without ongoing case supervision by international partners. Specific Aim 3 will address this critical issue by comparing CETA modified for independent implementation (mCETA) to standard CETA (sCETA) and waitlist controls. Professional gains obtained from the structured training opportunities will be engaged to complete the clinical trial. Collectively, the structured implementation of this Phase II application will establish a formidable culture of research innovation to address current and future mental health needs of the Cambodian population. Outcomes will inform treatment strategies in other trauma-intense, resource restricted regions of the world.

Mentor:

Robert Paul, PhD
Professor
University of Missouri – St. Louis
Director, Missouri Institute of Mental Health