Research

 Supported by over $10 million in external funding annually, faculty members in the International Health Institute conduct transdisciplinary global health research across the spectrum. This work includes:

  • Community-engaged randomized clinical trials among populations living with HIV and other chronic conditions;
  • Mathematical modeling of infectious disease transmission and human migration patterns;
  • Formative, qualitative and mixed methods studies with community partners, women, adolescents and children;
  • Development, implementation, and rigorous evaluation of evidence-based interventions that promote easier access to care; and
  • Long term capacity building in IHI partner countries through interdisciplinary applied training programs and focused mentorship.

Our research leverages longstanding partnerships with international collaborators; IHI faculty have been working with public and private institutions in South Africa, Bangladesh, Kenya, Mexico, Samoa and elsewhere for more than 30 years, and many IHI faculty hold joint appointments at these institutions. 

Some of the active global health research projects held by IHI faculty are highlighted below (information is as of August 2023). A complete list of active research projects can be found on each IHI faculty members’ website.

Areas of Focus

Treatment and Prevention of Infectious Disease
  • Harambee: Integrated Community-Based HIV/NCD Care & Microfinance Groups in Kenya ​
    Multiple Principal Investigators: Omar Galarraga (Contact PI) and Becky L Genberg
    ​​​​Agency: NIH/NIMH (R01MH118075) 
    The objective of this project is to use a cluster randomized trial to demonstrate the effectiveness and longer-term sustainability of a differentiated care delivery model for improving HIV treatment outcomes. The central hypothesis is that the integration of HIV care delivery and community-based primary care with group-based microfinance will improve retention and rates of viral suppression among people living with HIV in Kenya via two mechanisms: improved household economic status and easier access to care.
  • Testing the Efficacy of Safe South Africa:  An Intervention to Prevent HIV Risk and Interpersonal Violence Among Adolescent Boys  
    ​Investigators: Catherine Mathews and Caroline Kuo (Multi-Principal Investigators); Abigail Harrison (co-I) and others
    Agency: NIH/NIMH (1R01MH129-161-01A1)
    Our long-term goal is to prevent risk behaviors relating to HIV/STIs and IPV perpetration in a global priority population/setting by expanding our prevention toolbox through developmentally- and gender-tailored interventions. In this study, our overall objective is to test the    efficacy of Safe South Africa, an integrated HIV-IPV intervention that uses correction of misperceived social norms to prevent HIV risk and IPV perpetration among adolescent boys 15-17 years. This efficacy trial focuses on individual-level prevention in Safe South Africa,    complementing a school community-level prevention (R34MH124469) that we are currently testing.
  • Masibambane ('Ladies Chat'): Developing a Gender-Focused PrEP Information-Motivation Intervention for Young South African Women​
    Investigators: Jill Hanass-Hancock and Susie Hoffman (MPIs); Abigail Harrison (co-I) and others
    Agencies: NIH/NIMH (R34MH11578), NIH/NIAID (T32AI114398), South African Medical Research Council SIB grant 2019
    This NIH-funded intervention development study focuses on HIV prevention through PrEP in the context of reproductive health and gender equity. The study, conducted in partnership with the Columbia University HIV Center for Clinical and Behavioral Studies and the South African Medical Research Council, is based in Durban, South Africa, an epicenter of the global HIV pandemic, where young women face disproportionately high levels of HIV.  In Phase 1 of this study, researchers developed an online workshop based on in-depth formative research with young women and men, and used a peer recruitment and peer support approach to consider optimal strategies for implementing PrEP to lower HIV risk for diverse youth populations.   
  • The Role of Casual Contact and Migration in XDR TB Transmission in South Africa: a Geospatial, Genomic and Social Network Study
    Investigators: Sarita Shah, PIs, Emory University; Mark Lurie Co-I
    Agency: NIH/NIAID 5R01AI138646
    An epidemic of extensively drug-resistant tuberculosis (XDR TB) has converged with the long-standing HIV epidemic in South Africa. We have previously demonstrated that transmission is driving the spread of XDR TB, yet the majority of this transmission could not be traced to either close contacts or healthcare-associated transmission. The CONTEXT (Casual Contact and Migration in XDR TB) study will integrate geospatial, genomic, and social network data to comprehensively characterize the contributions of casual contact and migration to XDR TB transmission and generate concrete, actionable data to inform targeted public health interventions to curb the XDR TB epidemic.
Treatment and Prevention of Non-Communicable Chronic Conditions
  • Impact of the obesity-risk CREBRF p.Arg457Gln variant on energy expenditure, intake, and substrate utilization in Samoans
    Multiple Principal Investigators: Stephen McGarvey (Contact PI), James Delany                   
    Agency: NIH/NHLBI (R01HL140570)
    There is a fundamental gap in our understanding of the reasons behind the high prevalence of obesity in Samoa, which is among the highest observed across the globe. In a genome-wide association study we recently identified a novel missense variant (p.Arg457Gln, minor allele frequency 0.259) in CREB3 Regulatory Factor (CREBRF) that is highly associated with BMI, with an effect size greater than any known common BMI risk variant. The overall goal of this research project is to gain insight into the metabolic differences responsible for the excess weight gain associated with the CREBRF variant.
  • Clinical Impact of a Community based Low-Sodium Salt Intervention to Reduce Blood Pressure at the Population Level in Rural Bangladesh: A Randomized Control Trial
    Principal Investigator: Malabika Saker
    Agency: Stanford King Center GHHMO Junior Faculty Grant
    This cluster-randomized controlled trial will involve 309 households in rural Bangladesh previously identified and characterized by the BRAC James P Grant School of Public Health, BRAC University (BRAC JPGSPH). These households will be randomly assigned to three arms: (1) control, i.e., no intervention; (2) information only, i.e., community health workers will provide basic information on high blood pressure, the health consequences of excessive salt consumption, and feedback to the participant on the likely quantity of salt s/he consumes (estimated using a questionnaire); (3) free LSSS arm: the same information as in arm 2 will be provided, but participants will receive 6 months of free low-sodium salt along with education on the benefits of LSSS. One male and one female adult (age ≥ 18 years) in each household will be invited to participate, the exclusion criteria being households with members known to have high serum potassium levels, are taking medications known to elevate potassium levels (e.g., ACE inhibitors, ARBs, potassium-sparing diuretics), are already taking potassium supplements, or those who have known kidney disease or abnormal serum creatinine at baseline. The primary endpoint will be blood pressure at 6 months post-intervention.
  • Early life determinants of cardiometabolic health from birth to adolescence amongst HIV-exposed and unexposed South African children
    Multiple Principal Investigators: Jennifer Pellowski (Contact PI), Angela Bengston, Heather Zar
    Agency: NIH/NICHD (R01HD108048)
    In this proposal, we leverage the Drakenstein Child Health Study, a well- characterized cohort of HIV-exposed but uninfected (HEU) and HIV-unexposed (HU) participants followed from birth, to investigate how HIV-exposure and early life infections affect inflammatory response changes to the metabolome from birth to early adolescence, and evaluate how these changes influence the development of adverse cardiometabolic outcomes in early adolescence.
Mobility and Human Migration
  • Mobility Analysis for Pandemic Prevention Strategies (MAPPS)
    Principal Investigator: Mark Lurie
    Agency: National Science Foundation, Predictive Intelligence for Pandemic Prevention (PIPP) Phase I
    This project will provide a framework to collect, capture, curate and analyze complex, multi-scale human movement and social interaction data that can be adapted to understand a wide variety of pressing problems including climate change, tracking of wildlife, disaster relief, management and urban planning. With the establishment of the Center for Mobility Analysis for Pandemic Prevention Strategies (MAPPS) at Brown University, this project aims to: categorize, organize and synthesize existing data on mobility and social mixing; develop new and innovative tools for measuring mobility and social mixing; and use that information to develop and populate mathematical models aimed at predicting and preventing future pandemics. 
    See Project website: https://www.mappsproject.com/
  • Tuberculosis Prevention in South Africa: Understanding User Experience and Feasibility with Geolocation Tracking Using a Mobile Device Application
    Principal Investigator: Mark Lurie (PI)
    Agency: Lura Cook Hull Trust
    In this study we investigate the feasibility of using a cell-phone-based application to measure human mobility among a group of patients recently initiating TB treatment in Eastern Cape, South Africa
  • Migration, Urbanization and Health in a Transition Setting
    Investigators: M White (Principal Investigator), S McGarvey (Co-I), M Lurie (Co-I) and others;
    Agency: NIH/NICHD (HD083374-01A1)
    This five-year observational study aims to shed light on issues of how mobile individuals acquire and manage chronic diseases and access long-term care, combining insights from a new longitudinal cohort study of 4,000 migrants and stayers and more than twenty years of extant data for a population of now more than 100,000 in demographic surveillance. Our study site is a district in rural northeast South Africa and the locations to which migrants from that origin move. 
  • Healthcare system resilience in Bangladesh and Haiti in times of global changes (climate-related events, migration and Covid-19)
    Investigators (Select): Malabika Sarker
    Agency: French National Research Agency as part of the presidential call “Make Our Planet Great Again” (MOPGA); co-financed by the Centre National de Ressources et de Resilience
    Since climate change, pandemics and population mobility are challenging healthcare systems, empirical and integrative research to study and help improve the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective. 
Women, Adolescent, Child and Sexual Minority Health
  • Improving Mental Health Among Colombian and Venezuelan Children and Youth Affected by Armed Conflict: Adaptation and Implementation of Two Trauma-informed, Evidence-based Interventions 
    Multiple Principal Investigator: Alethea Desrosiers (Contact mPI), Maria Piñeros-Leaño (MPI)
    Agency: Conrad N. Hilton Foundation
    Researchers will culturally adapt and pilot-test two trauma-informed, evidence-based interventions—practices or programs that have been proven effective through outcome evaluations. These will help serve the needs of some of the more than 8.1 million internally displaced persons  (IDPs) officially recognized as victims of the five-decade conflict in Colombia, as well as the approximately 1.8 million Venezuelans who fled to Colombia to escape their country’s economic devastation, violence, and political repression.
  • Adherence to HIV treatment postpartum: the implications of transitions among women living with HIV in South Africa
    Agency: NIH/NIMH (K01 MH112443)
    Globally, prevention of mother-to-child transmission initiatives have been widely effective at reducing the rates of perinatal infections, however, postpartum mothers living with HIV are still at increased risk for HIV treatment non-adherence, which is crucial to infant and maternal well-being. There is an urgent public health need to determine the dynamic factors that result in sub-optimal ART adherence as women transition from pregnancy to postpartum and to develop bio-behavioral interventions to address these factors to improve HIV treatment adherence postpartum. Overall, this approach has the potential to decrease mortality during motherhood and reduce the transmission of HIV, both vertically and horizontally. 
  • Empowerment through Education and Entrepreneurship for Indigenous Adolescents in Ecuador
    Investigators: Omar Galarraga (Principal Investigator), Alethea Desrosiers (co-Investigator)
    Agency: Brown University Population Studies and Training Center Seed Funds
    We propose to adapt and evaluate a multifaceted program to break the cycle of low-skilled jobs and high fertility among indigenous adolescents (IA) in Ecuador. The program will enhance human capital in two ways: (1) by providing entrepreneurial skills to enable IA to start income-generating activities; and (2) by increasing access to comprehensive sexuality education to enable IA to make informed decisions about sex, reproduction, and marriage. Research activities will include program adaptation based on cultural norms, and a pilot to test feasibility and acceptability. Sexual health education will be delivered through an existing online platform, and vocational modules will be delivered in afterschool “entrepreneurship clubs”. We will culturally adapt the program to Cotacachi, Imbabura, Ecuador (a region with high indigenous concentration), and recruit N=60 male and female IA in their last years of high school in Cotacachi (n=30 randomized to the intervention and n=30 controls).  
  • Schools Championing Safe South Africa: An Intervention Engaging Teachers and Students in Adolescent Prevention of HIV risk and Intimate Partner Violence
    Multiple Principal Investigators: Abigail Harrison (Contact PI), Caroline Kuo (American University), Catherine Mathews
    Agency: NIH/NIMH (R34MH124469)
    This research addresses the context of social norms related to violence and HIV risk behaviors among secondary-school going boys in metropolitan Cape Town, South Africa, in partnership with American University, Washington DC and the South African Medical Research Council.  In this study, we develop and investigate the acceptability and feasibility of Schools Championing Safe South Africa, an integrated HIV-IPV intervention where teachers and student peers engage adolescent boys in a developmentally-tailored approach to prevent adolescent HIV risk behavior and IPV using a social norms approach. We work in South Africa, a country with the largest HIV epidemic and some of the highest rates of IPV in the world. We propose the following specific aims: (1) Development aim – Gather behavioral and social norms data from teachers and students (aiming for 75% of students) relating to student-level prevention of HIV and IPV in 3 schools to inform the social norms campaign content for Schools Championing Safe South Africa; (2) Refinement aim – Refine content for the social norms poster campaign and other intervention components using n=5-10 interviews with teachers and k=3-6 focus groups with students in School #1 (poster campaign refinement school); and (3) Acceptability and feasibility aim – Conduct a randomized controlled pilot trial of the social norms campaign comparing School #2 (experimental intervention school) versus School #3 (wait list control school) with 1- and 6- month follow-up to measure change among students at high risk for sexual risk behavior and IPV perpetration (e.g., adolescent boys 15-17 years), and to assess the acceptability and feasibility of the intervention. 
  • HIV risk reduction intervention for transwomen with intimate partner victimization
    Multiple Principal Investigator: Shufang Sun (Contact PI),  Don Operario, Dawn M Johnson
    Agency: NIH/NIMH (R34 MH119968)
    This treatment development research will develop and evaluate the feasibility, acceptability, safety, and initial effects of a brief intervention that concurrently targets HIV and intimate partner violence (IPV) risk, as well as that addresses inter-related risks of HIV and IPV (e.g., substance use and PTSD) for transgender women. The proposed intervention will be based on the Gender Affirmation Framework, which emphasizes interpersonal processes to positively affirm the identities and unique needs of transgender people, and will also integrate a trauma-informed empowerment approach, which is the model of choice when working with survivors of IPV. The intervention is hypothesized to reduce HIV risk within the context of IPV and related risk factors (e.g., substance use and PTSD), and to improve a range of primary prevention behaviors such as condom use, pre- exposure prophylaxis (PrEP), and repeat HIV testing.
Digital and Mobile Health (mHEALTH) Interventions
  • Mobile Health (mHealth) Tools to Improve Delivery Quality of a Family Home Visiting Intervention
    Principal Investigator: Alethea Desrosiers
    Agency: NIH/NIMH
    This study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the Family Strengthening Intervention for Early Childhood Development (FSI-ECD) evidence-based behavioral home-visiting intervention, and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care.
  • Mobile Health Intervention to Increase HIV Self Testing and Linkage to Services for High-Risk Men in China
    Investigators: Don Operario (Contact PI), Shufang Sun (co-Investigator)
    Agency: NIH/NIMH (R01 MH123352)
    We propose an intervention entitled “WeTest- WeLink” that builds on years of formative work with MSM in China (R34MH106349). Guided by the Information- Motivation-Behavioral (IMB) model and Minority Stress Theory, we will employ a user-centered design process to refine and expand app features to support repeat HST uptake, behavioral risk reduction, stigma coping strategies, and self-efficacy to link to HIV care. We will use an Effectiveness-Implementation Hybrid Type 1 design consisting of a three site, 2-arm RCT to test HST and linkage to HIV related care outcomes as well as qualitative research to examine implementation and scalability. We will recruit 1,800 HIV negative MSM in three cities with HIV high-prevalence among MSM – Chengdu (9%), Suzhou (13%), Wuhan (11%) – allocated to the intervention (access to the WeTest-WeLink app) or control group (education about HST and passive referral to HIV care for individuals who test HIV positive). We will assess participants at 6-, 12-, and 18 months to measure intervention effects on primary outcomes: repeated use of HST (including photographic confirmation) and linkage to care for individuals who test HIV-positive.
  • Developing Internet-Delivered, Mindfulness-based Intervention to Reduce HIV Risk and Promote Mental and Sexual Health among Young Adult MSM
    Principal Investigator: Shufang Sun
    Agency: NIH/NCCIH (K23 AT011173)
    The HIV epidemic disproportionately affects young adult gay, bisexual, and other men who have sex with men (YMSM; age 18-34), a population largely impacted by stigma (i.e., minority stress) and mental health issues, both create a “syndemic” condition surrounding sexual risk behaviors and suboptimal HIV testing. Mindfulness-based interventions (MBIs) are efficacious in reducing psychological distress and promoting behavioral health, and successful adaptation of MBI for content and internet-delivery may offer an innovative, transdiagnostic, and scalable approach to reach YMSM and address this public health issue. Using an evidence-based adaptation model (ADAPT-ITT) for HIV behavioral health, the current project aims to systematically adapt mindfulness-based stress reduction (MBSR), an empirically-supported intervention with efficacy, to the context of HIV prevention and minority stress reduction via internet-based delivery among distressed, high risk YMSM, followed by a randomized feasibility trial.  

 

Strengthening International Collaboration
  • Building Research in Inter-Disciplinary Gender and HIV through the Social Sciences (The BRIDGES Programme)
    Investigators: Christopher James  Colvin (Contact PI), Mark Lurie (co-Investigator) and others
    Agency: NIH Fogarty International Center (D43TW011308)
    The BRIDGES Programme aims to strengthen interdisciplinary HIV social science research capacity at the University of Cape Town by providing training to PhD and Postdoctoral Fellows in two Thematic Areas of focus: 1) Reducing HIV incidence in adolescent girls and young women, and 2) Improving the performance of men in the HIV cascade. This project is a collaborative effort between the University of Cape Town (lead institution), Brown University (key collaborator), the Desmond Tutu HIV Foundation, the South African Medical Research Council, and Sonke Gender Justice.
  • NAMBARI, the Moi-Brown Partnership for HIV Biostatistics Trainin;
    Investigators: Joseph Hogan and Ann Mwangi (MPIs); Mark Lurie (co-Investigator) and others
    Agency: NIH Fogarty International Center (D43TW010050)
    Statistics training in Kenya has typically been theoretical in nature with applied work focusing primarily on biometry and agricultural statistics, and there is a substantial need for expansion of expertise among current faculty and development of potential new faculty members at Kenyan Universities. NAMBARI – “numbers” in Kiswahili – is a research training program that aims to expand research and curricular capacity in HIV-related biostatistics and advanced quantitative methods at the graduate and post-doctoral level at Moi University in Eldoret, Kenya.
  • Integrated Modeling of Epidemiologic and Economic Long-term Outcomes in Africa
    Principal Investigator: Omar Galarraga, Brown University
    Agency: NIH (Fogarty International Center)/ PEPFAR
    The inMODELA training program responds to the need for more data by supporting the development of mathematical models that can estimate the burden of HIV and non-communicable diseases (NCDs) in Kenya and South Africa. These models additionally quantify the effects of integrated care, and evaluate the preliminary cost-effectiveness of integrated interventions. Training is provided via applied practice exercises, lectures, group work, and publications.
Mentoring Early Career Investigators (2018-2023)
  • Group-based economic incentives to improve adherence to antiretroviral therapy among youth living with HIV in Ghana
    Trainee: Anthony Enimil, MD, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
    IHI Faculty Mentor: Omar Galarraga
    Award: CFAR International Developmental Grant
  • Feasibility and Acceptability of Enhanced Patient Care (EPC) for Adult HIV Patients with Unsuppressed Viral Loads in Western Kenya
    Trainee: Juddy Wachira, PhD, Moi University, Eldoret, Kenya
    IHI Faculty Mentor: Omar Galárraga
    Award: K43 (NIH Emerging Global Leaders Award), Fogarty International Center
  • Integrated Modeling of Epidemiological and Economic Long-Term Outcomes in Africa (inMODELA): An Emulator Tutorial in Kenya
    Trainee: Faith Yego, PhD, Moi University, Eldoret, Kenya
    IHI Faculty Mentor: Omar Galárraga
    Award: CFAR International Developmental Grant
  • Targeted Learning for Improved Prediction and Effect Estimation in the HIV Care Cascade
    Trainee: Kirwa Kipruto, PhD, Moi University, Eldoret, Kenya
    IHI Faculty Mentor: Mark Lurie
    Program: Fogarty AIDS International Research Training Program (AIRTRP); Degree of Doctor of Philosophy in the Brown University Graduate School and the Department of Epidemiology
  • Undetectable and Untransmittable: reducing HIV transmission among young women living with HIV, their partners and children in South Africa
    Trainee: Elona Toska, PhD, Centre for Social Science Research, University of Cape Town, South Africa
    IHI Faculty Mentor: Abigail Harrison
    Award: K43 (NIH Emerging Global Leaders Award), Fogarty International Center
  • The Prevalence and Associated Factors of Hypertension among HIV Patients
    Trainee: Grace Mbuthia, RN, PhD, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
    IHI Faculty Mentor: Steven McGarvey 
    Program: The Consortium for Advanced Research Training in Africa (CARTA); Postdoctoral mentorship 
  • Effects of intergroup contact via media on people’s attitudes towards gender and sexual minorities
    Trainee: Siqi Feng, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore
    IHI Faculty Mentor: Shufang Sun
    Program: Doctoral program mentorship 
  • Risky drinking, drug use and HIV treatment outcomes among young pregnant and postpartum women living with HIV in South Africa
    Trainee: Kirsty Brittain, University of Cape Town, South Africa
    IHI Faculty Mentor: Jennifer Pellowski
    Award: Providence/Boston CFAR Developmental Award; International Initial AIDS Research Project
  • Human rights and HIV testing and counseling services among female patients
    Trainee: Shehani Perera, PhD Student, Public Health, University of Cape Town, South Africa
    IHI Faculty Mentor: Jennifer Pellowski
    Program: Doctoral program mentorship  
  • Community-based Medication Adherence Support for Older Adults Living with HIV and Hypertension (CBA Intervention)
    Trainee: Jepchirchir Kiplagat, PhD, Moi University, Eldoret, Kenya
    IHI Faculty Mentor: Omar Galárraga
    Award: K43 (NIH Emerging Global Leaders Award), Fogarty International Center