ICRH Belgium Newsletter
4th of November, 2011
DIFFER Kick Off Meeting
The DIFFER project was officially launched after a two-day kick-off workshop in Mombasa, Kenya.
From Wednesday 12 October to Friday 14 October representatives of the six partner agencies gathered in Mombasa to discuss the project and plan the activities of the first 18 months. The work shop was followed by a public launching event inviting key Kenyan stakeholders.
DIFFER stands for ‘Diagonal Interventions to Fast-Forward Enhanced Reproductive health’ and aims at improving access to sexual and reproductive health (SRH) for the most vulnerable by a better linkage between interventions targeted at most-at-risk populations, in particular female sex workers, and the general reproductive health services. It will be implemented at four sites in Kenya (Mombasa), Mozambique (Tete), South Africa (Durban) and India (Mysore). The project has a strong south-south component and will translate previous successes and lessons learned in India to the Sub-Saharan African context.
During the first 18 months a thorough policy and situational analysis will identify the gaps and provide the information needed to design the intervention. A package of comprehensive SRH services will be developed for both female sex workers and women of the general population together with site-specific models of how to best integrate these two packages. At the end of the 5-year project the models will be evaluated for their feasibility, acceptability, effectiveness, cost-effectiveness and sustainability. ICRH-Belgium will take the lead and coordinate the project, the other partners being Ashodaya Samithi in India, ICRH-Kenya, ICRH-Mozambique, MatCH & the Centre for Health Policy of the University of the Witwatersrand in South Africa and University College London, UK. The DIFFER project is funded by the European Commission’s 7th Framework programme.
More information: yves.lafort@ugent.be
EVENTS
‘Friends of Patricia Claeys’ fund raising party
On November 19 2011, the second fund raising party of the ‘Friends of Patricia Claeys’ will take place in Ghent.
Epidemiologist and public health specialist Dr. Patricia Claeys has been living and working in Nicaragua before she became Health Coordinator at ICRH Belgium. Regrettably, she died far too early, in 2008, but her memory and her inspiration are kept alive by the not-for-profit association ‘Vrienden van Patricia Claeys’ (Friends of Patricia Claeys), established after Patricia’s death by relatives, friends and colleagues. The association supports several projects aiming at promoting health and fighting poverty among vulnerable populations in Nicaragua. The fund raising party will start at 7:30 pm in ‘Planeet Mars’, Land van Waaslaan 78, 9040 Sint-Amandsberg (Gent). There will be among others a picture exhibition, live music and several DJs. Income tickets are sold at 6 Euro. Donations to ‘Vrienden van Patricia Claeys’ can be done by bank transfer to the account of ‘Steunfonds Derde Wereld’, BE15 0010 4517 8030, with the message ‘Vrienden van Patricia Claeys’.
More information: www.patricia.claeys.be.
Child brides and child mothers
On December 9, ICRH is organizing an event entitled ‘Voices of child brides and child mothers in Africa’, aiming to share insights of two projects that have focused on the harsh realities of child brides, child widows and girls at risk of child marriage.
Marriage is often seen differently in many societies. Children forced into marriage, especially girls, are not physically, physiologically or psychologically ready for the responsibilities of marriage and child bearing. The two speakers have ample experience working against child marriage, both in Tanzania, UK and Sierra Leone:
-Koshuma Mtengeti, Coordinator of the Children’s Dignity Forum Tanzania;
-Naana Otoo-Oyortey from the Foundation for Women’s Health Research and Development from the UK.
Speakers will be introduced by Prof Dr Marleen TemmermanVenue: Filmzaal Plateau - Paddenhoek 3 – 9000 Gent
Start: 8 pm.
More information: els.leye@ugent.be
(r)Urban Africa
The Ghent Africa Platform is organizing its 5th symposium on December 2, 2011, in Ghent. The focus of ‘GAPSYM5’ is ‘(r)Urban Africa: multidisciplinary approaches to the African city'.
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With half of the world’s population living in urban centres today, urbanization (and rurbanization) has become one of the major challenges of this century. The fastest urban growth is taking place in sub-Sahara Africa. In this context, development programs have increasingly shifted their focus from the rural to the urban setting. Also academic research on Africa in general has gained an increasing urban focus, in all kinds of disciplines.
GAPSYM5 takes the African city as its central focus and seeks to approach this African urban context from a wide range of thematic domains: political sciences and anthropology, linguistics and agriculture, history and medicine, etc…
The symposium will take place in the Plateauzaal & Simon Stevinzaal, Ghent University, J. Plateaustraat 22, 9000 Ghent.
Pre-registration: 30 euro & 10 euro (Ba and Ma students) – deadline: November 20 2011
On-site registration: 50 euro & 30 euro (Ba and Ma students)
Registration required: GAP@UGent.be.
Information and registration: www.gap.ugent.be/GAPSYM5_en.
African Coordinating Centre on the Elimination of Female Genital Mutilation/Cutting
During a conference hosted by the University of Nairobi from October 17 to 19 2011, an African Coordinating Centre for Partnership, Capacity Building, Research, and Policy Making for Abandon-ment of Female Genital Mutilation/Cutting was established.
The International Conference on Research, Healthcare and Preventive Measures for Female Genital Mutilation/Cutting and Support for Capacity Strengthening of Leadership and Research in Africa was organized in collaboration with the University of Sydney, Australia, the International Centre for Reproductive Health at Ghent University, Belgium and the University of Washington, Seattle, USA, UNFPA, UNICEF and WHO. It took place in the Southern Sun Mayfair Hotel, Nairobi and was attended by researchers, government officials, UN staff and representatives of NGOs and bilateral agencies from 17 countries across the world.
The conference covered the following topics on FGM/C: implications of the recent prohibition in Kenya; global challenges in the elimination; state of the art on health and research; abandonment efforts in Africa; complications and their treatment; work against FGM/C in Norway; legal and human rights aspects in Kenya; psychological and sexual consequences and treatment; the role of social norms, culture and conventions in the perpetuation and abandonment; prevention of medicalization; community-based interventions for the elimination and design considerations for the evaluation of FGM/C initiatives.
The final day of the conference was dedicated to establishing an African Coordinating Centre for Partnership, Capacity Building, Research, and Policy Making for Abandonment of Female Genital Mutilation/Cutting to be based in the University of Nairobi. The Centre will develop innovative approaches to increase and deepen the understanding on issues relating to FGM/C and its elimination; to train leaders and champions in promoting and using multidisciplinary actions for eliminating FGM/C and to promote health care for victims.
More information: els.leye@ugent.be
ICRH Kenya at the EDCTP Forum
The Sixth EDCTP Forum was held from October 9 to 12 2011 in Addis Ababa, Ethiopia. The theme of the Forum was Strengthening Research Partnerships for Better Health and Sustainable Development. During this meeting, members of the ICRH Kenya staff held three oral presentations and presented one poster.
Mary Mwaura, Principal Investigator of the Kenyan site in the multi-country study ‘Characterisation of novel microbicide safety biomarkers in East and South Africa’ presented preliminary screening data collected in Kenya, Rwanda and South Africa. ICRH Kenya’s laboratory manager Sammy Wambua reported on the implementation of HPV genotyping in the ICRH Kenya research laboratory and on the preliminary results of a study on HPV typing of HIV infected pregnant women. ICRH Kenya’s data manager, Mary Thiongo, presented on behalf of the Data Management Network the lessons learned from the EDCTP funded trials. Furthermore, Sammy Wambua presented a poster on the capacity build in the CPGH-ICRHK research laboratory in Mombasa.
The abstracts of the posters can be found in the ‘Publications’ section of this newsletter.
ICRH PEOPLE
Wim Delva
Visiting professor Wim Delva to investigate sexual network structure and the impact of early initiation of HIV treatment.
Dr. Wim Delva has been appointed visiting professor at ICRH from 1 October 2011 for a period of 3 years. Wim is a senior researcher at SACEMA (South African Centre for Epidemiological Modelling and Analysis) and former ICRH-affiliated PhD student at Ghent University. Although living and working in Cape Town for most of the year, he visits ICRH-Ghent regularly to prepare joint research proposals, to assist with statistical analyses and to discuss publication plans.
Using statistical and epidemiological modeling techniques, Wim wants to push the envelope of understanding how different sexual network structures influence the spread of HIV in heterosexual populations, and how earlier initiation of HIV treatment could be implemented in a feasible, affordable and cost-effective way. Recent clinical trials have shown that earlier access to antiretroviral therapy not only prevents HIV-related morbidity and mortality for the HIV-infected patient, but also reduces the probability of HIV transmission to his or her uninfected sexual partners.
More information: wim.delva@ugent.be
Wei-Hong Zhang
On the 27th of September, ICRH senior researcher and project coordinator Dr. Wei-Hong Zhang was offered a position of Visiting Professor by Chongqing Medical University (CQMU).
CQMU, originally known as Chongqing Medical College, was founded in 1956, growing out of Shang-hai First Medical College (the present Shanghai Medical College of Fudan University). The university is located in the city of Chongqing, which is the economic center on the upper reaches of the Yangtze River and the newest municipality directly under the administration of the Central Government. With more than fifty years of development, CQMU has become a key university under the administration of Chongqing Municipal Government with an integrated educational system of Bachelor's, Master's, Doctor's and Postdoctoral programs in medicine as well as other related fields. The university has a staff of 5,228 personnel, of which over 300 are professors and over 800 associate professors.
More information: WeiHong.Zhang@UGent.be
Birgit Kerstens
On October 1st Birgit Kerstens joined ICRH as consortium project administrator of the MOMI project.
Until recently Birgit worked as an independent consultant in health economics and health financing, which she will continue to do part time. Her short term consultancy assignments include formulations, evaluations, cost-effectiveness and costing studies, and health expenditure reviews and her field experience is mainly in Africa and the Caribbean. Birgit supported ICRH several times in the preparation process of project proposals for funding under the European Union's 7th Framework Programme and now hopes to contribute to the smooth project implementation by the European and African partners of the MOMI consortium.
More information: birgit.kerstens@ugent.be
Stéphanie De Maesschalck
In October, Stéphanie De Maesschalck started working for ICRH on the EC-funded CERCA project (Community-Embedded Reproductive health Care for Adolescents in Latin America). 
Family physician Stéphanie De Maesschalck will be planning and teaching communication skills training sessions for healthcare providers working in health centres in a.o. Cuenca, Managua and Cochabamba. The focus of these sessions will be on talking and counseling about reproductive health with adolescents and their parents. The CERCA project aims at improving reproductive health (salud sexual y reproducativa) for adolescents in Central and South America. ICRH performs this project in cooperation with South Group (Bolivia), the University of Cuenca (Ecuador), the University of Amsterdam (Netherlands), the National Autonomous University of Nicaragua, and the Instituto Centro Americano de la Salud (Nicaragua).
Besides her work at ICRH, Stéphanie is also teaching communication skills and cultural competences to medical students at the department of Family Medicine and Primary Health Care, Ghent University. She is about to finish a PhD thesis on the physician-patient relationship with ethnic minority patients. Furthermore, 2 and a half days a week she work as a family physician in a state refugee centre (Fedasil) where refugees from around the globe reside during the first months of their asylum procedure in Belgium.
More information: Stephanie.DeMaesschalck@UGent.be
PhD students staying at the ICRH office in Ghent
Tizta Tilahun Degflie from Ethiopia and Emily Mwaliko from Kenya are staying at the ICRH office in Ghent to work during a couple of months intensively on their PhD research.
Tizta Tilahun Degfie is lecturer at the Population and Family Health Department of the Public Health Faculty of Jimma University, Ethiopia. She holds an Msc in population studies and works on a PhD research project entitled ‘Husbands’ Involvement in Family Planning: Couples Perspective in Jimma Zone Ethiopia’. More information: tiztatilahun@yahoo.com.
Emily Waleghwa Mwaliko holds a Master in Medicine, Obstetrics and Gynecology and a Master in Public Health. The topic of het PhD research is ‘Factors associated with delayed presentation of women with advanced stages of cancer of the cervix’. Having worked in the department of reproductive health for over 10 years, Emily has noted that women with cervical cancer arrive very late for review and therapy and the majority doesn’t survive for long after diagnosis. Identifying the main factors causing delay will provide a basis for measures to increase early detection. This is especially valuable in resource limited settings where treatment of cancers in late stage is out of reach for the majority of patients. More information: waleghwaem@hotmail.com.
PUBLICATIONS
Prevalence of reproductive tract infections in women targeted for microbicide trials
Mary Mwaura from ICRH Kenya presented preliminary screening data on novel microbicide safety biomarkers in East and South Africa.
The ideal microbicide should reduce the risk of HIV infection while preserving the integrity of the cervicovaginal epithelium. RTI could hamper the effect of microbicides. The Microbicide Safety Biomarkers study seeks to establish baseline RTI prevalence in a prospective cohort of adult pregnant and non-pregnant women and adolescents from three sites in East and South Africa. 430 women were enrolled by August 2011 and will be followed up over 7 visits. Biomarkers of cervico-vaginal inflammation, target cells, the microbiome, and RTI will be studied. Preliminary screening data were presented during the meeting. The researchers conclude that among African women targeted for microbicide trials, RTI are common and may vary by region, making it essential that the effects of RTI on the efficacy and safety of microbicides are evaluated. Prevalence of reproductive tract infections in women targeted for microbicide trials. Mary Mwaura for the Biomarkers Study Group. Oral presentation at the Sixth EDCTP Forum, 9 to 12 October 2011 in Addis Ababa, Ethiopia.
For more info on the Biomarker study, contact Mary.Mwaura@icrhk.org or Rita.Verhelst@UGent.be.
Prevalence of human papilloma virus infection in HIV infected women during the third trimester of pregnancy
At the EDCTP Forum in Ethiopia, ICRH Kenya’s laboratory manager Sammy Wambua presented a poster on the implementation of HPV genotyping in the ICRH Kenya research laboratory and on preliminary results of a study on HPV typing of HIV infected pregnant women.
Adult HIV-1 infected women at 28-36 weeks gestation were enrolled into the Kesho Bora Study, a randomized controlled trial assessing the effects of HAART on HIV-1 mother-to-child transmission (MTCT) during pregnancy, delivery and postpartum. For the purpose of HPV typing all women were selected for whom a cervico-vaginal lavage sample during pregnancy and 3 months post partum was available. So far, the presence of 28 different HPV genotypes in 250 pregnant women enrolled at the Mombasa site has been assessed using the INNO-LIPA HPV Genotyping Extra assay.
Results: PCR inhibition occurred in 4/250 samples (1.6%) and HPV DNA was found in 242/246 (98.4%) of women. While 83.3% of women are infected with one or more HR HPV types, only 28.9% are infected with HR types 16 and/or 18 and HPV 16 and HPV 18 occurred as single infections in less than 4% of women.
Conclusions: The high numbers of HIV/HPV co-infected women and high numbers of women with multiple HPV infections, are probably due to reduced immunity during pregnancy. To date, HPV 16 and HPV 18 are preventable with current vaccines. HPV 16 and/or HPV 18 DNA was found in 28.9% of women, though other high-risk types were commoner in this population of pregnant HIV infected Kenyan women.
Prevalence of human papilloma virus infection in HIV infected women during the third trimester of pregnancy. Mandaliya K, Wambua S, Ndinda M, Verhelst R, Mwaura M, Vanden Broeck D, Temmerman M, Luchters S. Oral presentation at the Sixth EDCTP Forum, 9 to 12 October 2011 in Addis Ababa, Ethiopia.
For more info on the Kesho Bora study, contact: Stanley.Luchters@UGent.be
For more info on HPV genotyping, contact Sammy.Wambua@icrhk.org or Davy.Vandenbroeck@UGent.be
Data management in non-commercial north-south collaborative clinical research
ICRH Kenya’s data manager, Mary Thiongo, presented on behalf of the Data Management Network the lessons learned from some EDCTP funded trials.
Introduction: Clinical Data Management (DM) faces many difficulties and challenges. This is especially true in academic environments, where the limited budget generally allows for small DM teams. Nevertheless, these teams have to comply with the same GCP and regulatory standards as the private sector and adapt to progress in medical research and rapid developments in IT. Resource-limited settings can present additional difficulties (e.g. intermittent internet connections).
Methods: A group of Northern and Southern clinical data managers met at the Antwerp Institute of Tropical Medicine in December 2010, to share their knowledge and experience with DM of non-commercial clinical research. In particular, lessons learned from the EDCTP 4-ABC and PREGACT malaria trials, the EDCTP Microbicide Safety Biomarkers trial, as well as other Southern-based studies were shared.
Results: Some challenges were found to be common at the start of projects: late involvement of data managers; workload underestimations and inadequate budget for some activities, e.g. database validation; lack (or handover) of human resources and of solid expertise in validation and programming; heterogeneous use in software and documentation at different sites, and sometimes low internet connectivity and power instability. In addition, finding open access software suitable for multicentre trials remains a challenge.
Conclusions and recommendations: There is a clear case for promoting a North-South collaborative platform of clinical data managers (as it happens among clinical researchers) aiming for good clinical DM practices. Training, the design of common operating procedures and document templates, and the development of a collaborative network are seen as the obvious next steps in meeting these goals.
Data management in non-commercial north-south collaborative clinical research: lessons learned from some EDCTP funded trials. Harry van Loen, Mary Thiongo, Anish Battara, Hercule Kalonji, Robert Meester, David Mwakazanga, Sayouba Ouedraogo, James Smedley, Sok Sopheak, Arouna Woukeu, Greta Gondol, Raffaella Ravinetto and Yves Claeys. Oral presentation at the Sixth EDCTP Forum, 9 to 12 October 2011 in Addis Ababa, Ethiopia.
For more info on Data Management in Clinical Trials or on the DM network, contact Mary Thiongo at Mary.thiongo@icrhk.org or Harry van Loen at hvanloen@itg.be.
EDCTP capacity building achievements at the ICRH clinical research laboratory in Mombasa, Kenya
At the EDCTP Forum in Ethiopia, ICRH Kenya’s laboratory manager, Sammy Wambua, presented a poster on the capacity build in the CPGH-ICRHK research laboratory in Mombasa.
Guaranteeing laboratories’ capacity to generate reliable and accurate data is vital for successful clinical research. Capacity strengthening is not only acquisition of modern equipment and reagents but also sustained commitment to training, quality, and biosafety. Through EDCTP capacity building grant, ICRH-Kenya undertook projects to improve clinical trial capacity.
Methods: A holistic approach was taken to strengthen infrastructure, equipment, training, and testing capacity. Local and/or sustainable solutions were preferred and were effected with GCLP-compliance and a long-term goal of accreditation in mind.
Results: A spacious building was refurnished to house the laboratory, then furnished with access control system, reliable electricity and water backups, and a state-of-art communication infrastructure serving staff and temperature e-monitoring system. Equipment acquired includes: ultra low temperature freezers fitted with temperature e-monitoring auto-dial system, autoclave, real-time and conventional thermal cyclers. Training designed to establish capacity so that the laboratory is subsequently able to do/renew its own trainings was done on biosafety, quality management systems, and GCLP. High-quality tests for Chlamydia, Gonorrhoea, HSV-2, HIV-1 viral load, and HPV genotyping, among others, were set up.
Conclusions: Overall, the laboratory experienced capacity growth manifest as augmented staff competence & confidence, expanded test repertoire, and improved appreciation for safety and quality leading to formation of a safety committee, and preparation of safety and quality manuals. With good foresight & management, capacity building grants can have lasting impact in resource-poor settings
EDCTP capacity building achievements at the International Centre for Reproductive Health (ICRH) clinical research laboratory in Mombasa, Kenya. Sammy Wambua, Stanley Luchters, Davy Van den Broeck, Rita Verhelst, Tania Crucitti, Janneke van de Wijgert, Nienke Veldhuijzen, Kishor Mandaliya, Marleen Temmerman. Poster presented at the Sixth EDCTP Forum, 9 to 12 October 2011 in Addis Ababa, Ethiopia.
For more info on the activities of the ICRHK research lab, contact: Sammy.Wambua@icrhk.org
or Rita.Verhelst@UGent.be.
State of the World 2011
On 26 October, UNFPA lauched its annual report ‘State of the World Population 2011 – People and Possibilities in a World of 7 Billion.
Seven billion people will inhabit the earth on 31 October 2011. This year's State of World Population report, People and Possibilities in a World of 7 Billion, looks at the dynamics behind the numbers. It explains the trends that are defining our world of 7 billion and documents actions that people in vastly different countries and circumstances are taking in their own communities to make the most of their-and our-world. The report makes the case for sound planning and investing in people.
The report can be downloaded at http://www.unfpa.org/swp
Journal for Gender Studies: Special issue on ‘Harmful Cultural Practices’
In September the ‘Journal for Genderstudies’ published a second special issue on ‘harmful cultural practices’.
While this issue focuses on Asian and African practices that are deemed harmful, a previous publication in March emphasized practices occurring in Europe, predominantly in migration settings. In this way, the ‘Journal for Genderstudies’ wants to call attention to this internationally arising but still contested concept. ICRH contributed to both issues in different ways. Dr. Els Leye acted as guest editor and various ICRH staff members contributed. Alexia Sabbe made an analysis on culture, migration and gender in forced marriage policies. In her article, Anke Van Vossole examined if wife inheritance exerts a protective or rather damaging influence on women. And Ines Keygnaert’s photo report demonstrates how women of the ‘Hidden Worries’ project experience violence. The issues can be ordered at http://www.tijdschriftgenderstudies.eu/.
More information: anke.vanvossole@ugent.be
The state of sexual and reproductive health within the European Union
REPROSTAT, a project aimed at describing the present state of Sexual and Reproductive Health and Fertility within the 27 European Union Member States, has published its final report.
A range of literature was reviewed in all 27 member states to create a SRH and policy "profile" for each member state, including existing official laws and guidelines; scientific and academic organiza-tions position papers, articles, book chapters, reports, guidelines; NGO documentation; relevant lay press analysis; and relevant "grey" literature. The local reviews were done by the REPROSTAT colla-borating partners in the member states. ICRH is member of the Steering Committee and collaborating partner for Belgium.
The final report is a critical analysis of the sexual and reproductive health within the European Union. It identifies major disparities and inequalities in five areas: teenage sexual behaviour and reproductive health, use of contraception and associated policies, childbearing support and public policies, assisted reproductive technologies (ART) and induced abortions among the member states. The report also contains recommendations for policy and monitoring.
Both the final report and the country profiles can be downloaded at http://www.reprostat3.eu/FinalReport.html