Updated on Aug 26, 2025 | AIGH
Videos used in the HADITHI study helped children understand why they need to take medicines to keep themselves healthy.
In July, 2025, the World Health Organization (WHO) released a new publication highlighting key research that will help health care providers tell children and adolescents that they have HIV.
In this Q&A, Rachel Vreeman, MD, MS, Director of the Arnhold Institute for Global Health at Mount Sinai, explains how research conducted through AMPATH Kenya contributed to the development of the WHO’s new guidance.
“This is a great example of how our approach to research—prioritizing close, equitable collaboration with our Kenyan colleagues and centering the voices and needs of youth—results in best practices and can influence policy globally,” she said.
What is the AMPATH Kenya partnership, and what is the Institute’s role with it?
The AMPATH Kenya partnership is a strong collaboration among Moi University and Moi Teaching and Referral Hospital in Eldoret, Kenya, the Kenyan government, and a global consortium of universities that includes Mount Sinai. Within AMPATH Kenya, the Arnhold Institute supports and leads activities to improve youth health in Kenya, including clinical programs, research, and capacity-building for adolescent health.
Medications used to treat pediatric HIV. A major part of the disclosure process is helping children understand why they need to take medications every day.
What is the new World Health Organization guidance document?
The guidance released this year summarizes key research on ways to tell children and adolescents about their HIV status in a safe and empowering way, known in the pediatric HIV field as “disclosure.” The WHO document helps health care providers and HIV programs understand what has worked in different contexts. I’m proud to note that research from the AMPATH Kenya partnership—work testing a new disclosure program for children ages 10 to 15—was highlighted as one of those key studies. I was a lead author on that study, along with my Kenyan counterpart Dr. Winstone Nyandiko, Professor of Pediatrics and Child Health. Now, this program to support disclosure is not only recommended nationally for Kenya, but is also part of what the WHO recommends globally. In addition to this intervention program, the WHO also cited AMPATH Kenya’s qualitative research describing other HIV disclosure practices for children.
Tell us more about what makes your study unique.
We named our study the HADITHI intervention, which is short for “Helping AMPATH Disclose Information and Talk about HIV Infection.” Hadithi also means “story” in Kiswahili, the language most of our Kenyan patients speak, because stories were what the initiative was all about. There are a lot of stories that people tell about HIV, many of them stigmatizing. So when you tell someone that they have HIV, especially a child, you’re playing a role in how they understand their own life story—is it happy or sad, shameful or empowering? The framing is very important. In this counseling we did in the program, we also used stories told by Kenyans to help the children understand their HIV status in a culturally sensitive way.
One other important element of the HADITHI study was our use of peer support groups in helping patients learn about and accept their diagnosis. In fact, peer support for adolescents continues to be a cornerstone of Mount Sinai’s work in HIV in Kenya. In the WHO guidance document, peer support was specifically identified as a key feature of disclosure interventions in this age group.
Why is the way disclosure is conducted for children so important?
When a child is living with HIV, at some point—often when they’re quite young, six or so, but sometimes not until they’re adolescents—their families and doctors must start the process of telling them their diagnosis. Eventually, they need to understand why they have to take medicines every day for the rest of their lives. And, they need to get this information in a developmentally appropriate way that fits the child’s age. Often, they’ve already heard a lot of rumors and misinformation about people living with HIV, and may be afraid of being a person with HIV. The process of telling them must therefore be done very carefully, in a way that reassures them that they can still live a long, happy, productive life. That is the process of disclosure, and it can take months or years of preparation and gradual teaching.
It’s so important that disclosure is done well, especially because many children get HIV from their mothers. We need to protect the bond between the mother and the child and empower the child or adolescent to feel good about themselves and begin to accept responsibility for taking care of their own health.
What does it mean to the Arnhold Institute and to you personally that this research was cited by the WHO?
As a career researcher in Kenya and a passionate advocate for children and adolescents, I am immensely proud to have contributed to this work at a global level. We at the Arnhold Institute and AMPATH Kenya are truly doing innovative and impactful work for children, and as a pediatrician, I can’t think of anything more rewarding than that.
Rachel Vreeman, MD, MS is a pediatrician, Director of the Arnhold Institute for Global Health, and Professor and Chair of Global Health at the Icahn School of Medicine at Mount Sinai.
Jul 30, 2025 | AIGH
The course participants with instructors Rachel Fischer, MD, left, and Melanie Brown, MD, MSc.
Mental health problems affect one in 10 adults in Nepal over their lifetime. The burden of mental health disorders has risen as the country recovers from a decade-long internal conflict, the 2015 earthquake, and the global COVID-19 pandemic.
In response to this urgent need, three psychiatry experts from Mount Sinai—Jan Schuetz-Mueller, MD, Rachel Fischer, MD, and Melanie Brown, MD, MSc—recently taught an intensive week-long course in global mental health for Nepali students (public health, nursing, medicine, and physiotherapy), faculty, and researchers at Dhulikhel Hospital Kathmandu University Hospital and Kathmandu University School of Medical Sciences. The comprehensive course equipped participants with essential skills to recognize, respond to, and research mental health challenges, and emphasized how to scale up services sustainably to meet the needs of low-resource communities of Nepal.
Dr. Brown explains the difference between psychosis and schizophrenia to course participants.
Using the skills and knowledge they learned from the course, participants researched current resources and needs and proposed solutions to improve existing health services to meet each region’s specific mental health needs in Nepal.
For example, from their experience at their placements at Dhulikhel Hospital’s rural community outreach centers, students identified unique local mental health challenges, such as mass hysteria outbreaks among school children. The participants proposed ways to train personnel to face these challenges, including training female community health volunteers in psychological support techniques so that they can better support those experiencing mental health problems in rural communities.
Feedback on the training was overwhelmingly positive. One student commented, “It increased my interest toward mental health issues globally.” Another shared, “What I find most inspiring about the course is its unwavering commitment to develop, train, and educate the students. This holistic approach not only addresses immediate mental health needs but also fosters the generation of health care professionals equipped to make a long-lasting impact on global mental health disparities.”
The Mount Sinai facilitators were likewise highly impressed by the high quality of the students’ work throughout the course, their engagement, and insight. The facilitators left inspired by the passion and aptitude of the next generation of Nepali mental health leaders and with a greater appreciation of Nepali culture that will help them treat their Nepali patients better in New York City.
Nepali students in the global mental health course
The course resulted from a productive collaboration between the Department of Public Health and Community Programs at Dhulikhel Hospital, Kathmandu University School of Medical Sciences, and the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. Across specialties, including critical care, neurology, and pediatrics, about 50 Mount Sinai experts have traveled to Dhulikhel Hospital to contribute expertise through Mount Sinai’s AMPATH Nepal partnership.
We hope this initiative will continue to inspire students in Nepal to engage in the field of mental health and contribute to meaningful and lasting improvements. We look forward to strengthening this valuable partnership in the years to come.
Biraj Man Karmacharya, PhD, is an Administrative Director at Dhulikhel Hospital, Chief Administrative Officer of Kathmandu University School of Medical Sciences and Director of the Masters of Science in Public Health Program and Department of Public Health and Community Programs
Akina Shrestha, PhD, is an Associate Professor in the Department of Public Health, Kathmandu University School of Medical Sciences, Nepal
Melanie Brown, MD MSc, was Chief Resident in Psychiatry at Mount Sinai Morningside and Mount Sinai West during the course, and is now a Fellow in Consult-Liaison Psychiatry at the New York University Grossman School of Medicine
Updated on Jun 20, 2025 | AIGH
Mount Sinai CEO Brendan Carr, along with members of the Mount Sinai team, meet with the Right Honorable Prime Minister KP Sharma Oli and representatives from Nepal.
Brendan Carr, MD, MA, MS, Chief Executive Officer and Professor and Kenneth L. Davis, MD, Distinguished Chair, Mount Sinai Health System, recently visited Nepal to see firsthand the work of the AMPATH Nepal partnership—a collaboration between the AMPATH Consortium of academic health centers led by Mount Sinai, Kathmandu University School of Medical Sciences, and Dhulikhel Hospital.
Over the course of the visit, Dr. Carr delivered the keynote address at the 30th Convocation of Kathmandu University, met with the Right Honorable Prime Minister KP Sharma Oli to discuss health priorities, and toured multiple community and hospital-based programs engaged in the AMPATH Nepal partnership. Dr. Carr’s visit highlighted the depth and impact of this unique collaboration, which is advancing health care delivery, education, and research in Nepal.
Convocation Address Highlights Compassion and Collaboration
In recognition of Mount Sinai’s contributions to health in Nepal and Dr. Carr’s leadership, he was invited to serve as the Chief Guest at Kathmandu University’s 30th Convocation. In his keynote address to graduating students, Dr. Carr reflected on the strength of the partnership and the power of shared learning across borders.
“Mount Sinai has a strong and impactful partnership with Kathmandu University School of Medical Sciences and Dhulikhel Hospital, built on a solid foundation of mutual respect, shared goals, and the understanding that we, as institutions, grow stronger through collaboration,” Dr. Carr said. “We are learning and growing together, adapting solutions to local realities, and strengthening health care systems in both Nepal and the United States. This exchange of ideas and expertise is not just improving care; it is broadening our perspectives, empowering both societies, and laying the groundwork for a healthier future for all.”
Dr. Carr also emphasized the importance of compassion in one’s professional life. “While collaboration is vital, there is another essential quality I want to emphasize today: compassion,” he said. “I truly believe the world does not simply need more experts—more physicians, more engineers, or more lawyers. It needs people who lead with compassion…The best science, the best medicine, the best technology—they can change the world. But to truly make a lasting impact, you must lead with compassion, humanity, and authenticity.”
At the ceremony, Professor Achyut Wagle, PhD, Vice Chancellor of Kathmandu University, affirmed the importance of the partnership. “Dr. Carr’s presence here is also to recognize the invaluable contribution of the Mount Sinai Health System in the advancement of medical education and health care system in Nepal in general, and at the Kathmandu University School of Medical Sciences and the Dhulikhel Hospital-Kathmandu University Hospital,” he said.
Click to watch the slideshow
Meeting With the Prime Minister to Advance Health Equity
Dr. Carr, along with the Mount Sinai team, also had the distinct honor of meeting with the Right Honorable Prime Minister of Nepal, KP Sharma Oli, at his residence. The meeting provided an opportunity to share updates on the AMPATH Nepal partnership and reaffirm Mount Sinai’s commitment to advancing health equity in collaboration with local institutions. The conversation focused on how the government and AMPATH Nepal can work more closely together to scale innovations, strengthen the public health system, and ensure long-term impact and sustainability for communities across Nepal.
Visiting Community-Based Health Programs
Dr. Carr also toured Dhulikhel Hospital and its Baluwa outreach center, where he observed several key community health initiatives, including efforts to strengthen the emergency care system, as well as hypertension and diabetes screening programs. In Panauti, he visited sites where the partnership is conducting comprehensive cervical and breast cancer screening and follow-up care for all women in the municipality—an effort to improve early detection and reduce cancer-related mortality.
Another highlight of the visit was observing the growing critical care partnership between Mount Sinai’s Institute for Critical Care Medicine and the Dhulikhel Hospital ICU teams. Together, they are working to elevate the standard of critical care in Nepal through clinical collaboration, shared learning, and infrastructure development.
Dr. Carr’s visit concluded with words of appreciation from the Right Honorable Prime Minister Oli, who expressed gratitude to Dr. Carr and the Mount Sinai team for their enduring commitment to strengthening Nepal’s health sector.
Dr. Carr’s visit to Nepal further strengthened the AMPATH Nepal partnership, deepening institutional ties and showcasing the meaningful impact of our collaborative work. It helped raise national awareness of how sustained, equitable collaboration is improving health systems—and lives—throughout Nepal and beyond.
Rose House, MD, MS
AMPATH Nepal Partnership Director, Arnhold Institute for Global Health
Associate Professor of Emergency Medicine, Pediatrics and Global Health
Icahn School of Medicine at Mount Sinai
Updated on May 30, 2025 | AIGH
Mary Ott, MD, MA, the Arnhold Institute for Global Health, and partners at the ribbon cutting of the Adolescent Health Clinic at Dhulikhel Hospital in Nepal
Dhulikhel Hospital and the AMPATH Nepal partnership recently launched an Adolescent Health Clinic at the hospital. The clinic was the culmination of months of work and training that brought adolescent health experts from Mount Sinai’s Arnhold Institute for Global Health to Nepal to train and support Nepali health workers in providing world-class care to adolescents.
The clinic provides comprehensive, integrated care every Thursday for young people ages 10-19, aiming to improve access to adolescent-centered health services at Dhulikhel Hospital and its surrounding rural communities. Through a collaborative approach involving doctors, nurses, psychologists, and other health professionals, the clinic offers holistic care across key areas such as reproductive health (including family planning, menstrual health, and adolescent gynecology), mental health, and chronic disease management, with a focus on supporting youth in transitioning to adult care. This integrated approach reflects a deep commitment to meeting the diverse and evolving needs of adolescents in a safe, supportive, and inclusive environment.
AMPATH Nepal is a collaboration of Dhulikhel Hospital and Kathmandu University School of Medical Sciences in Nepal, and the AMPATH Consortium of academic medical centers led by the Arnhold Institute for Global Health at Mount Sinai.
Medical and nursing students trained to roleplay as adolescent patients celebrating the first adolescent clinical training at Dhulikhel Hospital
A Growing Need for Adolescent Care
The need for the adolescent clinic was initially recognized at multiple levels. Dhulikhel Hospital pediatricians saw that their adolescent patients often had mental health issues and other concerns that medical providers weren’t equipped to handle. School nurses in the community shared the concern that they weren’t sure where to refer adolescents, especially young girls, who asked for reproductive health services, or who needed mental health care.
Prithuja Poudyal, MD, a pediatric neurologist and Assistant Professor of Pediatrics at Dhulikhel Hospital, was one of the concerned providers. She noted that her patients with chronic illnesses didn’t have experts to turn to when they needed to navigate the transition to adult medical providers, a transition that can be scary and intimidating. Adolescents may also be seen as “challenging” patients because they are asserting their independence and testing boundaries.
Dr. Poudyal and others saw an urgent need for specialized training for Dhulikhel Hospital providers to help their patients navigate this tricky developmental stage by providing adolescent-friendly services and “transition” care: services that help youth with chronic diseases bridge the transition to making their own medical decisions, without their parents and with new, non-pediatric health care providers. Dr. Poudyal joined several faculty members to advocate for their patients and establish an adolescent clinic at Dhulikhel Hospital. The Arnhold Institute for Global Health provided the expertise, through the Global Youth Health Program, to plan, develop, and launch the clinic.
Dhulikhel Hospital’s First Adolescent Health Training
In March 2024, a team from the Arnhold Institute traveled to Nepal to conduct the first adolescent health provider training at Dhulikhel Hospital. The program began by training youth to roleplay as adolescent patients, followed by two, four-day sessions of provider training. The course combined evidence-based lectures with interactive sessions where clinicians practiced communicating and counseling with the youth in various scenarios. More than 50 health care providers from nine departments across Dhulikhel Hospital participated in the training, gaining practical experience in delivering youth-friendly, respectful, and confidential services.
The Adolescent Clinic Launch
Building on this momentum, Dhulikhel Hospital launched its Adolescent Health Clinic on Thursday, April 24. Many of the faculty and staff members who had participated in the training attended. The youth who had acted as patients were excited to see that the training they helped provide would be put to good use.
Dr. Poudyal and Mary Ott, MD, MA, Associate Director of Global Youth Health Programs at the Arnhold Institute, both spoke at the inauguration, along with Ram Kantha Makaju Shrestha, Dr. med. univ., the founder of Dhulikhel Hospital. In her speech, Dr. Ott said, “We hope to build on young people’s strengths and capacities and involve young people themselves in creating new and innovative solutions. The clinic represents a shift in how Dhulikhel Hospital sees adolescents—not as a big risk, but a huge opportunity.”
Vhari Forsyth, MBBS, MRCPCH, is Program Manager of Adolescent Health Programs at the Arnhold Institute for Global Health.
Updated on May 23, 2025 | AIGH
A youth standardized patient working through scenarios with clinicians
To improve health care for youth in western Kenya, the Arnhold Institute for Global Health at Mount Sinai and our AMPATH Kenya partnership held a pivotal clinical training for health care providers who work with adolescents.
The Institute leads the adolescent health initiative of the AMPATH Kenya partnership, a collaboration between Moi Teaching and Referral Hospital and Moi University in Eldoret, Kenya, and a consortium of global academic medical centers. The need for this training was identified at the AMPATH Kenya Youth Summit held in January 2024 and became a strategic priority of the partnership.
Hands-On Skills-Based Learning: About Youth, With Youth
The training, held in Eldoret, Kenya, brought together nurses, doctors, clinical officers, and other health care professionals from Moi Teaching and Referral Hospital, USAID AMPATH Uzima, and community clinics across Western Kenya that frequently interact with adolescent patients. Over five days, clinicians participated in a rigorous 30-hour course focused on developing youth-friendly interviewing skills and counseling techniques, earning continuing education credits upon completion of the course.
Participants of the adolescent health clinical provider training in Eldoret, Kenya
Youth played an essential role in the course’s success. In the days leading up to the course, which was held in January, a group of young people received two days of training to serve as “standardized patients.” These trained youth acted in the role of the adolescent in common clinical scenarios corresponding to the lecture content. This allowed clinical providers to immediately practice the skills they learned in the lecture portion of the training with the youths themselves.
Content lectures were delivered by faculty from the Arnhold Institute, Moi Teaching and Referral Hospital, Moi University, and adolescent medicine experts from East African countries. Topics included the HEADDSS interview (a psychosocial tool for assessing adolescents); motivational interviewing; consent and confidentiality; pubertal assessment, sexual history and family planning; mental health and substance use; and adolescent transitions.
The training paired one hour of skills lab practice session for every hour of content. Each skills lab group included four to five participants, a facilitator, and one youth standardized patient. Clinicians took turns practicing scenarios with the youth standardized patient while the facilitator and other participants provided structured feedback at the end of each scenario. Youth participants also gave feedback on how providers could be more youth friendly.
Scaling Up and Looking Ahead
This training is part of the Arnhold Institute’s broader effort to strengthen adolescent care within our global partnerships. An upcoming educational quality improvement project will focus on implementing locally the World Health Organization’s guidelines for adolescent health and refining the clinical provider training model to improve providers’ knowledge, attitudes, and confidence in adolescent care.
Additionally, key implementation outcomes of the clinical training—including reach, feasibility, acceptability, and sustainability—will be evaluated to further implement and scale the training.
In March, the Arnhold Institute and our AMPATH Nepal partnership culturally adapted and delivered a similar clinical provider training in advance of launching an adolescent health clinic at Dhulikhel Hospital in Nepal in April. With these early successes, the Arnhold Institute hopes to implement this training across all of the Institute’s partnership sites.
Sakshi Sawarkar is an Associate Researcher at the Arnhold Institute for Global Health, where she supports the Adolescent Health initiatives.
