On a hazy day in Kisumu, Kenya, a group of visitors watched as water sprayed the African kale crops on a small farm. National Institute for Mental Health Director Joshua Gordon was trying out an irrigation pump from Kickstart International that serves as a gateway to better health and food security for people living with HIV in Kenya. The small patch of land belongs to Maureen, a friendly woman with a ready smile who credits the Shamba Maisha farming study with giving her a steady income, better health and a more positive outlook. Shamba Maisha, which means “farming for life", is one of the innovative UCSF HIV prevention and treatment studies that 3 directors from the National Institutes of Health traveled across the world to visit.
UCSF receives more National Institutes of Health (NIH) funding than any other public institution in the US. It wasn’t an easy road for the NIH directors to go see the fruits of that collaboration in action. In 2017, they traveled all the way to Kenya, only to have to turn right around and head back to DC because the government had shut down. Determined to make the visit happen this year, National Institute of Mental Health Director Josh Gordon, National Institute of Child Health and Human Development Director Diana Bianchi and Fogarty International Center Director Roger Glass flew thousands of miles yet again to immerse themselves in UCSF’s work in Kisumu.
Kisumu County is one of the regions hit hardest by the HIV epidemic in Kenya. Its HIV prevalence is three times higher than the national average. Several NIH research studies in the area are affiliated with Family AIDS Care and Education Services (FACES), a collaborative between UCSF and Kenya Medical Research Institute (KEMRI). The program cares for over 45,000 patients on treatment in Kisumu County —3 times the number of people living with HIV in San Francisco. The NIH directors and visitors from UCSF saw that research and treatment come to life through the people directly impacted by the research. Mary, a participant in Carol Camlin’s study on the impact of mobility on HIV treatment, described the perseverance required to take antiretroviral drugs at the same time every day while she travels to purchase goods to sell to support herself and her family. She might miss an alarm on her phone because it’s buried in her bag to evade thieves at a market, or have to choose between taking her pills at that exact moment or catching a motorbike to her next destination. Women participating in Susan Meffert’s Mental Health Impact of Gender-Based Violence (MIND) shared harrowing stories of intimate partner violence and struggles with mental health while living with HIV. The study addresses these challenges with integrated treatment for depression and trauma disorders.
“Connecting directly with the patients who benefit from this research was an invaluable experience,” said Jody Steinauer, MD, MAS, director of the Bixby Center for Global Reproductive Health. “Hearing about how the struggles to access and stay in care play out in their daily lives gave me such respect for their persistence and highlighted the importance of UCSF’s work to develop new and innovative ways to improve their care.”
Retention in care is a major challenge that UCSF research aims to address. The team from Elvin Geng’s ADAPT-R Studydemonstrated a peer navigation session, one potential intervention in their work to assess different approaches for preventing lapses in care. The group then boarded a van to head to the bustling Lumumba Adolescent Center, one of 8 FACES facilities in Kisumu County that provides treatment, peer support and fun activities to adolescents living with HIV. Clinic staff talked about the constant flow of patients through the center, standing near kid-friendly murals extolling the virtues of the HPV vaccine. The holistic support adolescents get at the centers helps them achieve Operation Triple Zero—zero missed appointments, zero missed pills and zero viral load.
They ended the day at the Shamba Maisha farm, where the group gathered under a tree while participants Maureen and Michael shared the stories of their success while baby chicks peeped in the background. Investigators Sheri Weiser and Craig Cohen provided context for Shamba Maisha’s unique approach to improving retention in care and overall health and well-being through farming and business training and loans.
The successes in these partnerships between UCSF and NIH are just the beginning, with studies planning to branch out to bring interventions to new populations who can benefit and further refining approaches to scale up and reach more people in need. NIMH Director Joshua Gordon noted how these innovative approaches are reverberating far beyond Kisumu, including testing similar approaches to HIV treatment in the US. Reflecting on the trip, he wrote, “Through cutting-edge research around the world, global efforts yield truly global impacts.”