Updated on Jan 25, 2024 | AIGH
From left to right, Florence Jaguga, Ashley Chory, Ken, Vallary, Josephine Aluoch, and Lonnie Embleton representing the Adolescent Health Initiative at the AMPATH Kenya Global Gathering.
Since 2015, Mount Sinai, through the Arnhold Institute for Global Health, has participated in the Academic Model Providing Access to Healthcare (AMPATH) Consortium, a collaboration between Moi Teaching and Referral Hospital and Moi University in Eldoret, Kenya, and a number of North American academic medical centers.
In 2019, Mount Sinai became the lead Institution for the AMPATH Adolescent Health Initiative, which is housed at the Rafiki Centre for Excellence in Adolescent Health. In this role, Mount Sinai is responsible for the strategic development and systems strengthening of the care, research, education and community advocacy programs focused on adolescents.
Lonnie Embleton, PhD, MPH
Starting with the Rafiki Centre for Excellence, efforts are ongoing to expand the existing infrastructure to provide comprehensive and integrated care to all adolescents free-of-charge, regardless of HIV, housing status, or other characteristics. Comprehensive and integrated youth-friendly services encompasses providing holistic care across clinical specialties, including primary care, infectious disease, sexual and reproductive health, nutrition, and psychiatry, among others. Through the establishment of the framework of these goals, Mount Sinai will advocate towards improving the lives of adolescents in Kenya.
Working groups at AMPATH have been a vital and unique resource for research collaboration and activity since the program’s inception. These multi-disciplinary-focused groups were created to provide a bridge between clinical care and research, and to foster collaboration, particularly between researchers across the AMPATH consortium.
Florence Jaguga, MBChB, MMed
In July 2023, Mount Sinai formally took leadership of and formalized the AMPATH Adolescent Health Working Group, which includes representation from clinicians, researchers, public health and policy experts, and youth across the partnerships. The groups’ leadership follows AMPATH’s counterpart model, and is chaired by Lonnie Embleton, PhD, MPH, Assistant Professor, and Florence Jaguga, MBChB, MMed, with Josephine Aluoch and Ashley Chory serving as secretaries. The group also includes peer-elected youth leaders, Vallary and Ken, who are responsible for providing feedback on program and research proposals, as well as other youth-specific contributions to the working group.
By centering on AMPATH’s tripartite mission of care, education, and research, Mount Sinai has shaped the working group’s strategic domains around similar principles. The overarching goal of the adolescent health initiative is to ensure healthy lives and promote well-being for all adolescents in Kenya centered on delivering high-quality and standardized adolescent youth-friendly services.
The working groups’ purpose is to provide a forum for discussion of adolescent health programs and to identify gaps in existing resources; discussions span the complex topics and needs of adolescents globally. Additionally, a comprehensive research program, the establishment of health professional training, and the creation of long-term funding options can all contribute to enhancing adolescent health. Our aim is to develop, implement, and evaluate a robust set of standards, policies, educational, research, and fundraising activities over 10 years.
Sakshi Sawarkar, MPH is an Associate Researcher, Arnhold Institute for Global Health and Department of Global Health and Health System Design
Ashley Chory, MPH, is Senior Program Manager, Global Adolescent Health for the Kenya partnership at the Arnhold Institute for Global Health and for the Department of Global Health and Health System Design.
Jan 15, 2024 | AIGH
Sangina Ranjit Malla, MD, left, and Bhawana Regmi, MSc
Sangina Ranjit Malla, MD, and Bhawana Regmi, MSc, trained and visited Mount Sinai through the Arnhold Institute for Global Health’s global health education program in September 2023 for one month.
Dr. Ranjit is an Associate Professor, Department of Anesthesiology and Critical Care, at Dhulikhel Hospital and Kathmandu University School of Medical Sciences in Nepal. Ms. Bhawana is a lecturer for the Department of Medical Surgical Nursing and Nurse Manager, Adult Intensive Care Unit and Surgical Intensive Care Unit, at Dhulikhel Hospital in Nepal. They work closely together in Nepal and are both very passionate about global health.
In this Q&A, they discuss what they hope to learn from their visit to Mount Sinai.
Can you both please tell us a little bit about yourself and your work?
Dr. Malla: I am an anesthesiologist, currently working in the operating room as well as the intensive care unit. I joined Dhulikhel Hospital in 2003 and since then, I am committed to the principle and objective of my Institute: “quality health care for the poor.” I completed my anesthesiology residency in 2008 in Nepal and, over the years, I have developed a special interest in critical care, cardiac anesthesia, trauma, and resuscitation. My team and I provide perioperative care for specialized surgeries like neurosurgery, gastrointestinal surgery, cardiothoracic and vascular surgery, trauma, obstetrics, and pediatrics. Since we are growing and have more specialized surgeries, procedures, and disease conditions, we are encountering more sick patients. This inspired me to learn more about critical care and bring programs that will help my patients to have better outcomes. I also teach students earning a Bachelor’s Degree in Medicine/Surgery (MBBS) and an MD in anesthesiology.
Ms. Bhawana: I have been working in the adult intensive care unit and surgical intensive care unit of Dhulikhel Hospital as a nurse manager since September 2018. I am basically responsible for the staff, patients, and students in the adult and surgical Intensive care unit. I have also worked as a lecturer in the department of medical surgical nursing since September 2015. I teach critical care nursing and adult nursing.
What do you both hope to learn from your time visiting Mount Sinai and the Institute?
Dr. Malla: I would like to learn about specific procedures used in intensive care, as that is rare and inaccessible to learn in Nepal. For example, I want to observe how slow real replacement therapy is performed in the ICU. Since stronger broad-spectrum antibiotics are often used in the ICU, I want to learn how antibiotic stewardship has been practiced in Mount Sinai. I would also like to develop a rapid response team/critical care outreach, so I would like to observe how it is done in Mount Sinai. In addition, I would like to learn more about overall treatment and how critical care pathways are followed in the ICU. These pathways could be guideline, protocol, or a specific care plan for a specific disease.
Ms. Bhawana: I would like to observe nursing care being provided to the critically ill patients and the use of nursing process. I am interested in the involvement of nurses in the planning, implementation and evaluation of patient care and the involvement of nurses in the doctor’s round. Also in the different protocols being used for patient management; infection prevention policies and protocols; different diagnostic and treatment modalities for patients admitted in ICUs; and simulation regarding critical care procedures for students.
How do you both think you can apply what you learn from the visit to your work in Nepal?
Dr. Malla: The skills, techniques, and approaches that I will observe at Mount Sinai, I shall apply them to my daily practice with the critically ill patients back home. In addition to changes in my own practice, I shall develop protocols and guidelines in my ICU so that my colleagues, students, and nurses will be able to follow a better critical care medicine. Also, I shall develop small critical care training packages for my nurses and residents so that ongoing teaching and learning activities will multiply and propagate the skills I have gained to better care for our critically ill patients.
Ms. Bhawana: I will incorporate the knowledge, skills, and approaches learned there for myself, my staff and student’s practice. We will focus on improving patient care by developing different standards for providing nursing care and on making policies and protocols regarding critical care. As nurses are the most important members in the critical care, their inclusion and visibility can be shown in patient care.
What do you both like about working in Nepal and in medicine?
Dr. Malla: I love my country and my people. This is the place where I can be myself and be happy for the rest of my life. We have the responsibility to make the country worth living. If we don’t do it, who else will? This is my home and I love working to make this home safe and beautiful. Since health and medicine is the basic need of any citizen, I feel proud to be working in this field. Medicine is a noble profession that involves life-saving care. Anesthesiology and critical care is all about acute care and life-saving care, and this is what makes me content.
Ms. Bhawana: Nepal is a beautiful paradise on earth. It has a variety of landscapes, cultures, traditions, and friendly people. The people here have greater health needs because of ignorance, poverty, and lifestyle. The health system is very expensive in Nepal, as most of the health expenditure is out of pocket. So working with and for our own people has always been a matter of pride. We have so many learning opportunities in medicine in Nepal. On my team, all my colleagues are motivated, hardworking, and dedicated to their work. So it has always been my pleasure to work with them.
What is some advice you would give to someone wanting to work in global health and medicine?
Dr. Malla: Every human being deserves optimum quality health care. By working in global health medicine, one can participate in this revolution of improving the health of people globally. One can find tremendous opportunities for research and innovations that involves quality and equity in health care. Working in global health and medicine will definitely keep you proud and gratified.
Ms. Bhawana: Global health facilitates a broader understanding of global health challenges that rise above international borders. So the people who want to work in global health and medicine should not be restricted by society, economic, geopolitical, or security implications. Health care should be affordable and accessible for all.
Ashante R. Patterson is the Communications and Marketing Manager at Arnhold Institute for Global Health and the Department of Global Health and Health System Design at Mount Sinai.
Updated on Dec 8, 2023 | AIGH
Peer navigators play an integral role in the care provided to adolescents at the AMPATH Rafiki Clinic. The peer navigators at the MTRH-Rafiki Centre for Excellence in Adolescent Health serve more than 800 adolescents who have shared lived experiences, such as living with HIV, experiencing pregnancy during adolescence, and/or being street-connected.
Peer navigators create a sense of community in the clinic, a space without judgment where adolescents can interact and receive care without the burden of stigma. They connect adolescents to appropriate care services, improving engagement in care and subsequent care outcomes.
When the Rafiki Center Peer Navigator program first began in 2016, it consisted of only two peer navigators, one female and one male. Whitney was the first female peer navigator at Rafiki, and Ashley Chory, Senior Program Manager for Global Adolescent Health at the Arnhold Institute. Whitney served as a peer mentor at the Rafiki Center for three years, then transitioned to the role of study peer/peer researcher, working to help engage adolescents in research, especially those who may be harder to reach.
Ashley Chory
In this interview, Whitney discusses the impact that being a peer navigator has had on her life, HIV-related stigma and how it affects the peer navigator role, and the opportunities that working at the Rafiki Center has brought her. Whitney suggests possible improvements for the peer navigator program, such as integrating the program into the clinic more seamlessly, reducing provider stigma, and how to better support peer navigators employed at Rafiki.
What is a Peer Navigator?
A peer navigator is a young woman or man who helps a young person in care navigate the care system. Every time they have challenges, we are there for them and basically support them through the experience, because we speak the same language. Peer navigators are the bridge between adolescents and the clinic system and school, and with their parents.
Tell me about what a peer navigator does and your role at Rafiki and AMPATH as a young person.
Peer navigators worked at module 4 [the pediatric unit at Moi University Hospital] before the adolescent clinic was open. Module 4 is now a clinic for children from birth to 15 years old, before they are disclosed [made aware of their HIV status]. They transition to Module 4 after testing positive [for HIV] at the mother-child clinic. When I worked at module 4, it served those up to 24 years old (before the Rafiki center). I was one of the first peer mentors for adolescents at AMPATH.
My responsibilities as a peer navigator include giving group health talks to adolescents related to HIV management, facilitating group pre-test HIV education and psychosocial support, co-facilitating support groups, and providing one-on-one peer education to adolescent clients and their partners. I conduct tracing of priority adolescent clients who have not shown up to an appointment, refer adolescent clients to other services within the health facility, and encourage partner involvement in maternal child health and family planning services.
[At the Rafiki Center] the first person an adolescent meets is the peer. We talk about school, home. In the beginning of the program, counseling was not a choice, it was a part of engagement in the clinic. Now, you must have an issue before you join counseling, which is a barrier to receiving mental health care due to stigma and logistical barriers. We must create a safe space and guide the adolescents to counseling, referring them to care while maintaining confidentiality.
How long have you been a peer navigator at Rafiki/AMPATH?
I was a peer mentor for three year, and then transitioned to a study peer. Study peers help reach adolescents who may be interested or eligible to participate in research but may be harder to reach. Study peers follow the participant from care through to enrollment and participation in the study, and they help adolescents feel safe in sharing information.
How has being a peer navigator changed your life?
Being a peer navigator helped me accept myself, and gave me confidence to do things I didn’t think I could do. It also provided me with a platform where I can meet and interact with other peers. I learned a lot about peer mentoring, beyond the program for adolescents. The program helped me transition from peer mentor, to study peer, to the current day where I am going back to school to get a diploma in counseling. Peer mentoring is not the end goal, it is a stepping stone on my career path.
I don’t think I would have had the same opportunities if I wasn’t a peer—I have attended conferences, symposiums, have talked and presented for the county Ministry of Health, and have learned from many leaders in adolescent health. Every day I am motivated that there is more coming, and I will have new ideas and come back and share them.
What motivates you as a peer navigator?
How I am able to talk to an adolescent—I admit them, they look bad, they have no [medication] adherence, and I go through the whole process with them until I see that they are well and healthy and they are talking a lot. I oversee their care from day one of their hospital admission to their discharge, to their care at the clinic and good medication adherence. And then I can rest at night knowing I just changed my patient’s perspective on life. There are so many adolescents who come in and are doing so badly—I work with them and then they are better. I am also motivated by how my fellow peers treat me like their role model. They look up to me for advice, and I am always available for them to reach, unlike some nurses and doctors
How did being a peer mentor help you accept yourself?
Before, I didn’t see a role model for young people living with HIV. Peers can help. When I was younger, I did not have anyone who was living with HIV (and was not ashamed of it) for me to look up to. Previously I was too shy to talk about anything, about my story, and peers help normalize this life experience. I am no longer sad or crying, but laughing. It helped me with my self-worth. Now when I look in the mirror, there is nobody that can tell me anything about myself. I get sentimental watching other adolescents go through this.
What opportunities do you see for expansion of the clinic’s services?
The clinic needs more activities beyond clinical care. The way the country is going, adolescents are suffering to get jobs and to fit in. There are youth who have support from their parents, and others who do not. The clinic is a good setting to provide training that helps.
Adolescents sometimes forget what their purpose is in life. Peers can intervene to help adolescents figure out their goals, and use the clinic to push toward their goals. Peers need help transitioning into other things—skill building, and finding other opportunities. They need to be told to go back to school, so that they can be a model for younger adolescents. We should add other classes (they have planting now), to build skills. Adolescents don’t always know what classes are available to them. The classes should be tailored to ensure each and every adolescent belongs to a group and visits the Rafiki center during school breaks so they can learn when they have time.
Peer navigators should be more integrated into the clinic. Providers can be dismissive of peer navigators, which makes it hard to work together, despite the fact that they are all there for the same reason: adolescents. The Rafiki center has providers who are cool—they sometimes wear jeans—you think you are just at home.
There are many peer navigators now, maybe we can have a training where we get all of the peers from the different counties together in Eldoret, once a year. To network, learn from others, dance, etc. People can then go and actualize the ideas in their clinics. “Aging as a peer navigator” is a possible topic for exploration.
What is one thing that you wish people knew about the role of youth peer navigators?
Being a peer navigator does not exclude you from stigma—I am glad I can be a peer navigator because I can correct things that happen in the health care setting that are stigmatizing. We can air out some of the differences and problems that we see, and make it better for the younger kids. As one of the first peer navigators, I did not have an example or mentor for me to look up to. It took a lot of guts and self-talk to do it. Something you need to carry yourself, and do wholeheartedly—it is a calling, it is not a job.
Regarding stigma—We work with nurses, doctors, and outreach workers and sometimes they can be stigmatizing. If you ask a question, they may respond dismissively because of one’s HIV status. They are supposed to help you. They are the same people who tell clients that some employees are living with HIV—outing people, creating confidentiality issues between patients and providers. Peer navigators still feel the stigma, but you have to talk yourself out of it, because you are someone’s role model.
When peer navigators first began working at the Rafiki center, there was a question about whether they should be paid, or not, stipend or not. Getting a small stipend motivated me to be able to study, support my family. I still think they should provide more financial support. They are not just adolescents here to do this and that.
What is your favorite thing about working as a peer navigator?
Seeing a smile on a parent’s face. There were times when parents came to me to see what was happening with their child. That smile, after you’ve sorted out the adolescents—like checking in on a pregnancy scare, etc.—it is fine, they are all fine. Making the caregiver happy, it gives me happiness.
Looking back at how the peer navigator program has expanded makes me so happy. It used to be much smaller, there were just two of us, but now there are many, for all of the different kinds of needs. It has grown so much and that makes me so happy. I’m happy that the peer navigator program is a success. And all that we’ve been able to do in such a short time—getting adolescents [virally] suppressed, getting adolescents who were lost to follow up to come back to clinic, and adolescents joining the many psychosocial groups. My favorite thing is handing over the job and mentoring younger up-and-coming peer navigators at the clinic.
Outside of being a peer navigator what are you doing (such as school/education, working, parenting, looking for work)?
I transitioned to the research department working as a peer researcher. [Whitney has worked as a peer mentor on several studies, focused on addressing HIV stigma in the classroom, developing educational strategies to combat HIV stigma, assessing the impacts of the pandemic on Youth Living with HIV (YLWH), and examining stakeholder perspectives on reducing stigma in Kenya.] I’ve just received a diploma in psychological counseling. My goal in life is to start a clinic for mental health counseling for young people. I am also a commercial model, and a content creator. And I am an excellent makeup artist.
What are some words that best describe you?
Down to earth, outgoing, bubbly, jolly.
What do you want the world to know about young people and young people in Kenya?
Young people are special. They need to be understood, and given opportunities, as many as they want. They are in the midst of dealing with puberty, relationships, mental health struggles, and discovering themselves. They need nurturing, support and love from the people around them in order to make them better people. School, home, and clinic should all come together to support adolescents and support their goals. At the clinic, we are trying our best to support them—the school and their parents should do the same.
If you had three wishes, what would they be?
I wish there were no sicknesses in this world. I wish for many more wishes, so that I can cure the world.
Ashley Chory, MPH, is Senior Program Manager, Global Adolescent Health for the Kenya partnership at the Arnhold Institute for Global Health and for the Department of Global Health and Health System Design.
Ava Boal is an Associate Researcher.
Dec 6, 2023 | AIGH, Community, Diversity and Inclusion, Featured
Rachel Vreeman, MD, MS, speaks with Frank Anthony, MD, MPH, Minister of Health, Guyana (right)
The Icahn School of Medicine at Mount Sinai is seizing “an amazing opportunity” in global public health in a three-year initiative that is expanding health care to Guyana’s more than 800,000 citizens. Launched in 2022, the initiative is a partnership among Mount Sinai, the Hess Corporation, and the government of Guyana, and it is already bringing crucial health screenings to roughly half the nation’s eligible children.
“It is a profound honor to serve the people of Guyana in this mission to give everyone the best opportunity for a healthy and long life,” says Jeremy Boal, MD, Chief Clinical Officer of the Mount Sinai Health System, who is overseeing Mount Sinai’s efforts under the initiative.
Guyana is a racially and ethnically diverse nation at the northern edge of South America, with strong historic and cultural ties with nearby Caribbean nations. The nation entered a transformative era in 2015, when nearly 11 billion barrels of crude oil reserves were discovered offshore and its government began making plans to invest in much-needed infrastructure in many areas, including health care. Guyana’s National Healthcare Initiative was launched after John Hess, Chief Executive Officer of Hess and a member of Mount Sinai’s Boards of Trustees, approached Mount Sinai about partnering with Guyana’s government and Hess to expand health care in the country. The collaboration will make health care more accessible even to its most vulnerable citizens, including pregnant people and adults living with diabetes or cancer.
Working closely with Guyana’s government, a 40-member project team of experts from the Mount Sinai Health System are providing thought partnership to the country’s leadership to implement a range of improvements to the national health infrastructure of Guyana. These teams are led by the Mount Sinai’s Arnhold Institute of Global Health and Mount Sinai International, organizations dedicated to advancing Mount Sinai’s mission of delivering innovative, high-quality health care around the globe.
Initial steps: Increasing access to children’s health care, primary care for diabetics, and a “world class” pathology lab
Already underway is a national child and youth health initiative, the first primary care program for children in Guyana. Launched in August 2023, the program provides comprehensive health exams for all nursery school students in Guyana, children aged three to five years old. Within its first month the program conducted health screenings—including vision, hearing, and dental evaluation—on 50 percent of the eligible children in Guyana, and the program is now reaching every region of the country, including remote regions accessible only by boat or plane.
“We’re really proud to move this bold children’s health initiative forward with the Guyana Ministry of Health and Ministry of Education,” says Rachel Vreeman, MD, MS, Director of the Arnhold Institute for Global Health, which is guiding the program. “It provides the critical steps toward implementing a primary care system and more universal health coverage. We’re providing screenings that let us identify children’s health issues early and connect families and communities and schools with the health centers in a new way.”
Comprehensive school health screening in the indigenous community of Karasabai in Region 9, Guyana
The next step is to enhance the national primary care program for adults, which will initially focus on diabetes screenings. After developing new national guidelines on diabetes in partnership with Guyana’s Ministry of Health, Mount Sinai experts trained Guyanese health professionals to implement high quality screening and care for diabetes at every level of the health system. Under the program, which also supplies medication and equipment, the Guyanese providers will, in turn, travel across the country to train health professionals in their local communities.
“The diabetes care platform is a model for other ‘train the trainer’ programs and primary care efforts, which will expand to provide screening and care for health challenges across Guyana, including high blood pressure, cancer screening, mental health screening, and other chronic diseases,” Dr. Vreeman says. The diabetes training is accompanied by efforts to build an infrastructure of expertise, supplies, and referral pathways, explains Dr. Vreeman, noting that expanding primary care services throughout the country will prevent patients from having to travel long distances for care. The Arnhold Institute is also guiding the country in building a more robust health care workforce, as well as the eventual rollout of a national electronic health records system and national health information system strategy.
The health care initiative will also expand specialty and tertiary health care at both public and private health care facilities throughout the country, particularly in cancer and cardiovascular care. Under the partnership, Mount Sinai International is working with Guyana’s government to develop a strategic plan that will determine how and where these services will be implemented, and how they will be funded and staffed. While most of these services are still in the planning stages, a telepathology lab is expected to be in operation by January 2024. Using advanced remote technology, the lab will allow doctors in Georgetown, the nation’s capital, to work with Mount Sinai pathologists in New York to diagnose patients in Guyana.
“The technology will decrease the wait time in Guyana for high-quality pathology readings from two to three months to few days,” says Szabi Dorotovics, MD, MBA, President, Mount Sinai International, who is overseeing these efforts. “I don’t think I have to tell you how much of a difference that can make, especially in cancer care. The quality of the readings will be world class.”
Guiding quality improvements at Guyana’s largest hospital
Under the initiative, Mount Sinai is also consulting on quality and operational improvements with leaders from Georgetown Public Hospital Corporation in Georgetown, Guyana’s largest hospital, where roughly half of patients are women seeking maternity care. These include enhancements to its neonatal intensive care unit; accident and emergency services; fire and life safety procedures; information technology; pharmacy services; supplies, equipment, and technology; minor renovations to the hospital campus, and more. A major challenge faced by hospital leaders in rolling out these improvements is a lack of resources, including a shortage of nurses and equipment.
“What we have to do is work with them, given the constraints, and figure out what can we do,” says Art Gianelli, MBA, MPH, FACHE, Chief Transformation Officer for the Mount Sinai Health System, who is leading these efforts with the Mount Sinai International Group. “Maybe we can’t do what is ideal, but we can take practical steps to improve all of the areas.”
Most of these improvements involve process changes that make up the foundation of good care, explains Mr. Gianelli, some of which are already underway. “The next step is to build on this foundational work and start to drive changes in outcomes, but you have to start at the beginning.”
Hospital leaders have already made a number of quality improvements, such as installing soap dispensers throughout the building to help reduce the spread of hospital-acquired infections, and deploying hospital administrator “safety huddles” to improve awareness of potential safety issues. For Guyana’s largest and busiest hospital, where many patients travel long distances to obtain care, these changes are sure to have a positive “ripple effect” across the country, Mr. Gianelli says.
While Guyana’s health care initiative is still in its early phases, it is providing valuable insight into how to target, at a national level, social determinants of disease. This will allow the country to address problems early and provide community-based prevention strategies, according to Dr. Vreeman.
“Our teams feel really privileged to be serving as this partner for Guyana’s Ministry of Health,” says Dr. Vreeman, Chair of Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai. “It’s an amazing opportunity to be able to bring up to scale some of the most evidence-based practices for what works in global settings. Through this initiative, Guyana is improving access to care, especially for marginalized and vulnerable children, and for people living in remote communities who have often experienced systemic inequities.”
Updated on Dec 8, 2023 | AIGH
Health challenges or inequities can be driving forces for change. This has led the NYC Partnership to award one-year pilot funds to address health challenges faced by communities receiving care in the public health care system in Queens, New York. This funding will enable teams at NYC Health + Hospitals (H+H)/Elmhurst, NYC Health + Hospitals/Queens and Mount Sinai to conduct collaborative research studies and care improvement projects that help address the communities’ health needs and affect change.
The NYC Partnership is a collaboration between the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, the Global Health Institute at NYC H+H/Elmhurst, and NYC H+H/Elmhurst and Queens.
The collaboration aims to engage in health care improvements, training, and research to address the needs of local Queens communities receiving care in the public health care system.
One mechanism to achieve this goal is the Pilot Project Awards, which encourage multidisciplinary and inter-institutional pilot projects. An 18-person Selection Committee composed of members from Mount Sinai, NYC H+H/Elmhurst and Queens reviewed and scored 19 applications, resulting in the funding of five projects for up to $25,000 each. The Committee selected these five projects:
Clinical and social implications that may exist by maintaining or removing race correction from pulmonary function testing in a racially diverse vulnerable population-Alfredo Astua, MD, and Ricardo Lopez, MD
There is a movement underway to remove race as a factor in many clinical algorithms as it can unfairly influence treatment options. Race correction equations used in pulmonary medicine may be preventing patients from receiving appropriate treatments as well as misclassifying the severity of disease. This project evaluates the effect of race correction, and its removal, from pulmonary function testing in the racially diverse communities served by NYC H+H/Elmhurst and Queens. Results will be correlated with social determinants of health and geospatial analysis of patients’ residence to understand associations of these social and structural factors on pulmonary diagnostics.
Alfredo Astua, MD
Ricardo Lopez, MD
Zachary L. Hickman, MD
NYC Health + Hospitals/Elmhurst Mild Traumatic Brain Injury and Concussion Program-Zachary L. Hickman, MD
As the only Level 1 trauma center in western Queens, NYC H+H/Elmhurst cares for approximately 800 patients with a traumatic brain injury (TBI) each year. The majority of these injuries are mild, including concussions. All patients with mild TBIs should be followed as outpatients by brain-injury specialists for the management of ongoing or prolonged symptoms related to their head trauma and for potential comorbid conditions (such as depression, anxiety, PTSD, or substance use disorders). If TBIs are untreated or under-treated, there are significant psychosocial and quality-of-life ramifications. Disparities in health care access and delivery are known to exist for patients after a TBI. This project will establish the first multidisciplinary Mild TBI/Concussion Program within the New York City public health system at NYC H+H/Elmhurst to reduce health care inequities in TBI diagnosis, treatment, and outcomes.
Perspectives of family caregivers and clinic staff on standardized caregiver needs assessment within an urban safety net primary care clinic for older adults-Harriet Mather, MD, MSc, and Hadeel Alkhairw, MD
Family caregiving is an urgent public health challenge due to the rapid increase in family caregivers and the impact on caregivers, care recipients, and the economy. Community-based caregiver support services are important for improving caregiver wellbeing, yet uptake of these services is low, with evidence of sociodemographic inequities. Systematic identification and needs assessment of family caregivers in primary care is a vital first step to promote uptake of support services. Through interviews with family caregivers of older adults attending the medical primary care clinic at NYC H+H/Elmhurst and focus groups with clinic staff, the study aims to understand the feasibility, acceptability, and preferences of caregiver needs assessment in primary care. This study will inform the co-design of a caregiver needs assessment and support intervention for family caregivers of older adults.
Harriet Mather, MD, MSc
Hadeel Alkhairw, MD
Ben McVane, MD
Assessing the Health Needs of Newly Arrived Immigrants and Asylum-Seekers in Queens-Ben McVane, MD
New York City has seen a recent significant increase in the arrival of asylum-seekers. This project will conduct a health-focused needs assessment using respondent-driven sampling of newly arrived immigrants and asylum-seekers in Queens. Data will be used to plan, fundraise, and advocate for a New Arrivals Clinic at NYC H+H/Elmhurst to better address medical and social needs. Participants with unmet needs will be connected to appropriate resources through community partnerships with Make the Road New York and the Libertas Center for Human Rights at NYC H+H/Elmhurst.
Cardiovascular Precision Medicine and Remote Intervention-Eyal Shemesh, MD, and Deborah Reynolds, MD
Non-adherence to medical recommendations for controlling high blood pressure and cholesterol is the leading cause for adverse outcomes in patients with cardiovascular morbidity. This project will use a cardiovascular variability marker, unstable and variable blood pressure readings, identified from electronic health records as a marker of non-adherence to flag patients at increased risk for poor outcomes. Cardiology clinic patients will be enrolled in a remote intervention for three months to increase engagement in care and improve adherence to medical recommendations.
Eyal Shemesh, MD
Deborah Reynolds, MD
Payal Ram is the Research Program Coordinator for the New York City Partnership at the Arnhold Institute for Global Health, and the Department of Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai and the Global Health Institute at NYC Health + Hospitals/Elmhurst.
Oct 23, 2023 | AIGH
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
