I arrived in Eldoret, “The City of Champions,” at the beginning of September 2023 to embark on a three-month research elective within the Academic Model Providing Access to Healthcare (AMPATH). As a fourth-year MD/MPH dual-degree student at the Icahn School of Medicine at Mount Sinai, I hoped this project would serve as a culmination of my previous coursework in global health, research methods, and preventive medicine, as well as a preview into what my future career could look like, which I hoped would include a strong research component to inform my clinical and public health responsibilities.
Kevin Griffee (he/him) is a Class of 2024 MD/MPH candidate at the Icahn School of Medicine at Mount Sinai
I first became interested in research and global health in college, where I worked on a wide range of projects, including those aimed at improving perinatal health among underserved patients in Washington, D.C.; preventing the spread of Lassa fever in Benin and Togo; and understanding the central auditory deficits associated with HIV infection in Dar es Salaam, Tanzania. I ultimately received a Certificate in Global Health upon graduating, along with a major in neuroscience and minors in biology and Chinese.
Following my medical school matriculation, I became increasingly interested in HIV. The COVID-19 pandemic served as a striking reminder that a parallel viral epidemic, more than four decades old, was continuing to infect more than one million people annually, including almost 500,000 young people. I wanted to understand exactly why this virus has persisted, despite the availability of antiretroviral therapy (ART) to prevent transmission and pre-exposure prophylaxis (PrEP) to prevent acquisition. The optimist in me even hoped we could make HIV obsolete in a generation, provided we maximize every tool in our HIV care and prevention toolbox.
One way to do this is through improving ART adherence. Adherence among youth populations tends to be lower than among other age demographics, which increases the risk for viral failure, drug resistance, and secondary HIV transmission. Our team was therefore interested in assessing novel approaches for improving ART adherence in this population, specifically digital health interventions, like mHealth and eHealth. We found mixed but promising evidence supporting the use of these interventions, especially text message-based ones. We hoped our findings would help guide future research and clinical decisions in this relatively nascent area of digitally supported HIV care.
Another HIV tool we have yet to fully maximize is PrEP. When used as prescribed, PrEP can reduce the risk of acquiring HIV by up to 99 percent. Unfortunately, PrEP use is plagued by disparities in access. In Kenya, for example, preliminary studies have suggested youth experience lower rates of PrEP uptake and adherence compared to older adults. The goal of our current study is to understand why this is the case, a particularly critical question given the large burden of HIV among youth in Kenya. By better understanding barriers to PrEP access, we hope to expand PrEP delivery programs in a way that best meets youth needs.
Key to this PrEP project, and other HIV-related projects that preceded it, is the participation of youth. Youth have generously shared their experiences, insights, and in some cases, their blood samples, for the benefit of research and future advances in HIV care. Another project I am working on is critically examining what youth, along with caregivers and subject matter experts, think about this research, and specifically the practice of biobanking for longitudinal clinical studies. We want to ensure that this research is done ethically, and part of this is confirming that the perspectives of youth and other stakeholders are reflected in current biobanking-related policies and procedures.
Together, these research projects address part three of AMPATH’s tripartite mission of care, training, and research. I also hope that the findings from our PrEP study will be used to improve PrEP service delivery at AMPATH-affiliated clinics and will therefore address part one of this mission as well. For part two, the training piece, I have enjoyed working with the incredible peer navigators at the Moi Teaching and Referral Hospital (MTRH) Rafiki Center of Excellence in Adolescent Health.
Members of the adolescent health research team. From left: Kevin Griffee, Ashley Chory, Josephine Aluoch, Eslyne Jepkemboi, Dennis Munyoro, and Tabitha Njoroge.
Peer navigators are members of the community who serve as links between patients and providers, and who offer counseling and other support services for youth living with HIV. Among their many responsibilities, peer navigators work to strengthen care engagement, improve medication adherence, and reduce HIV-related stigma. I have really enjoyed getting to know the peer navigators and helping them refine their project ideas for the Young Leaders Pilot Program, a joint initiative by Mount Sinai, Moi University, and MTRH to accelerate the development of adolescent health programs at Rafiki and AMPATH more generally. I have also enjoyed helping lead a workshop series with the peer navigators covering topics in research and professional development.
Outside of these activities, I have spent my free time in Eldoret engaging in AMPATH-sponsored lectures and discussions, exploring downtown and surrounding areas, sampling the delicious local cuisine, participating in pick-up soccer games, and taking regular Swahili and sewing lessons.
Overall, I feel so privileged to stay in this beautiful place, honored to work with such wonderful mentors and collaborators, and grateful to be so kindly welcomed into this community. I am very much looking forward to the remainder of my time here, strengthening the relationships I forged so far, and continuing to work together to make progress towards equitable, patient-centered access to effective HIV treatment and prevention methods worldwide. I would like to thank AMPATH, Moi University, MTRH, and Mount Sinai’s Arnhold Institute for Global Health for making this experience possible.
Kevin Griffee (he/him) is a Class of 2024 MD/MPH candidate at the Icahn School of Medicine at Mount Sinai