Learn more about the new, interdisciplinary global health research projects supported by the Steinberg Fund for Interdisciplinary Global Health Research (2016-2019) and the GHP-MI4 Steinberg Seed Fund Grant (2020-2021) below.
The Contribution of Stigma Among Sexual Minority Men to HIV Transmissions in Sub-Saharan Africa
This project is funded via the GHP-MI4 Steinberg Seed Fund Grant.
Corresponding Principal Investigator: Dr. Mathieu Maheu-Giroux, Department of Epidemiology, Biostatistics, and Occupational Health
Co-PIs: Raoul Moh, Programme PAC-CI, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d’Ivoire
Nadine Kronfli, Department of Medicine, Division of Infectious Diseases, McGill University
To successfully eliminate AIDS as a public health threat, we must address the unmet prevention needs and disproportionately high HIV burden experienced by key populations –groups at high risks of HIV acquisition and transmission.
These elevated risks are exacerbated by widespread stigma and discrimination that act as barriers to accessing HIV services, especially among gay, bisexual, and other sexual minority men. Stigma refers to discrimination, prejudice, negative attitudes, and abuse directed at sexual minority men based on their identity and behaviors. Stigma could partly drive population-level HIV transmission beyond sexual minority men in sub-Saharan Africa since most of them also report female sexual partners.
The overarching aim of this project is to estimate the population-level impact of stigma to HIV transmission among sexual minority men in sub-Saharan Africa. To do so, we will conduct an individual-based meta-analysis of cohort studies. By pooling available studies, we will uncover the pathways through which stigma influences HIV acquisition and empirically quantify its impact.
HIV and human rights are inextricably linked. By providing critical evidence on the role of stigma in perpetuating HIV risks among sexual minority men, this project will inform stigma-based HIV prevention among key populations in sub-Saharan Africa and beyond.
Mathieu Maheu-Giroux is an Assistant Professor in the Dept. of Epidemiology and Biostatistics at McGill University where he holds a Tier II Canada Research Chair in Population Health Modeling.
His work focuses primarily on 1) infectious disease modeling, 2) epidemiology and measurements, and 3) impact and economic evaluations of public health interventions. The overarching of his program is to support the development of evidence-based policies and interventions to improve global population health with an emphasis on controlling/eliminating infectious diseases.
Prior to joining McGill in 2017, Mathieu received a doctorate in Population Health from Harvard where he was a Fulbright International Science & Technology scholar. He then completed a postdoctoral fellowship in mathematical modeling at Imperial College as a CIHR Bisby fellow.
Adaptive capacities and structured health vulnerabilities during disaster: Learning from the experiences of persons with disabilities in Kodagu District, India
Corresponding Principal Investigator: Dr. Matthew Hunt, SPOT
Co-PIs: Sébastien Jodoin, Law
Arun Maiya, Manipal University
Persons with disabilities (PWD) experience heightened risk of being harmed or wronged in situations of disaster or crisis. In the past two decades, increased attention has been paid to the ways that disasters impact PWD and to the development of strategies to respond to the needs of PWD in disaster preparedness and response. Despite these high-level recommendations, practical implementation of disaster preparedness, relief, and reconstruction often falls far short of an inclusive approach that is responsive to the diverse capabilities and needs of PWD. In this study, we will engage with the experiences of PWD in Kodagu District, Karnataka State, India who have been affected by flooding and landslides, and where a disability inclusive disaster response approach has been initiated. In doing so, we will draw together insights from the concepts of adaptive capacities and structured health vulnerabilities to orient our inquiry.We will conduct in-depth interviews and focus-groups with PWD, including leaders of Disabled Persons Organizations, as well as interviews with government officials and members of intergovernmental and non-governmental organizations. Our aim is to develop policy-relevant knowledge about planning and implementing inclusive disaster risk reduction and disaster response strategies from the perspectives of PWD.
A Family Integrated Care Model to Improve the Quality of Newborn Hospital Care in Uganda
Corresponding Principal Investigator: Dr. Jessica Duby, Department of Pediatrics
Co-PIs: Nancy Feeley, Ingram School of Nursing
Abner Tagoola, Jinja Regional Referral Hospital
Despite increased coverage of hospital-based maternal and newborn care, the neonatal mortality rate in Uganda remains persistently high. An insufficient number of health care workers is a significant barrier to providing optimal care in Ugandan hospitals. For hospitalized sick and small newborns, their own mothers may be a vital but largely untapped resource to improve the quality of care. In addition to being the most invested in their child’s outcome, mothers in Uganda typically stay at their newborn’s bedside throughout hospitalization. In high income countries, systematic efforts to engage parents in all aspects of their newborn’s hospital care, such as the Family Integrated Care Model (FICare), has resulted in improved outcomes for patients and parents. Our study will develop and test a regionally appropriate FICare model in a neonatal unit in a Ugandan public hospital. We will use a combination of qualitative and quantitative methods to evaluate the acceptability and feasibility of increased maternal participation in the neonatal unit. Our results will inform a subsequent, multi-center cluster-randomized control trial that evaluates the effect of a regionally-adapted FICare on the Ugandan healthcare system. This initiative may offer a sustainable and scalable solution to improve the quality of hospital-based care for sick and small newborns in low-resource settings.
A Collaborative Partnership to Develop Smoking Cessation Interventions in Nunavik
Corresponding Principal Investigator: Dr Faiz Ahmad Khan, Department of Medicine
Co-PIs: Amrita Daftary, Department of Epidemiology Biostatistics and Occupational Health, and Nathalie Boulanger, Centre de santé Tulattavik de l'Ungava
Tobacco use is the world’s leading preventable cause of non-communicable diseases (NCDs). The World Health Organization’s MPOWER framework for tobacco control, based in community and legislative action, has worked in most of Canada but failed in the Inuit region of Nunavik where 67% of adults continue to smoke cigarettes daily. Here, rates of hospitalization and death from smoking-related NCDs remain disproportionately high. Research involving Indigenous populations suggests that interventions should be designed in line with “Indigenous ways of knowing and doing”, and through the development of meaningful relationships with Indigenous community members. We propose to build such relationships with Nunavimmiut, with the overarching aim of collaboratively designing Nunavik-specific smoking cessation interventions. We will use participatory methods to conduct environmental scans, key-informant interviews, consultations and focus group discussions to explore contextual influences on smoking, and determine how evidence-based interventions can be tailored to the social fabric of the Nunavimmiut. The resulting knowledge, co-produced with all stakeholders, will be synthesized to select interventions for piloting with the support of community members and local village clinic staff. This initiative may help catalyze faster declines in smoking among the Nunavimmiut by sparking the development of effective, sustainable, and scalable smoking cessation interventions.
Men as protagonists in improving maternal and child health: Intervention research in marginalized indigenous communities in Guatemala
Corresponding Principal Investigator: Anne Cockcroft, Department of Family Medicine
Co-PIs: Monica Ruiz-Casares, Department of Psychiatry, and Luis Rolando Raiz Bekker, CIET International, Guatemala
Guatemala has some of the worst maternal and child health (MCH) statistics worldwide, and Indigenous communities suffer a disproportionate burden of illness. Paternal distress and substance use, inequitable gender attitudes, and domestic violence are major risk factors for maternal and child morbidity and mortality and poor child growth and development. Despite research highlighting the importance of fathers in promoting MCH, few studies have evaluated interventions targeting perinatal paternal involvement. No intervention studies have addressed paternal engagement specifically in indigenous contexts. Existing interventions, based on Western views of involved fatherhood, fail to capture indigenous perspectives and discount political and social determinants of paternal involvement. Using a participatory approach, our project will be among the first in Latin America to develop a holistic, collective, strengths-based intervention for addressing the wellbeing and positive engagement of indigenous fathers. Our pilot research, to pave the way for a subsequent community-led cluster randomized controlled trial, aims to create an evidence-based, feasible and locally acceptable community mobilization protocol to improve MCH through changes in gender norms, reductions in domestic violence and promotion of fathers’ wellbeing and positive engagement in MCH. Our innovative approach recognizes that community engagement in designing solutions is a key component of sustainable transformation.
International Health Regulations Compliance in India: The Politics of Global Health Security
Corresponding Principal Investigator: Raphael Lencucha, School of Physical and Occupational Therapy
Co-PIs: NichoIas King, Department of the Social Studies of Medicine, and Seema Sahay, National AIDS Research Institute
Today’s deeply interconnected world greatly heightens the trans-border risk of infectious disease. The spread of Ebola in 2015 illustrates this vulnerability, while revealing that many countries are ill-prepared to prevent, detect, assess, notify and respond to infectious disease outbreaks. Although national governments are charged with the responsibility of safeguarding the health of their citizens, these responsibilities are embedded in a web of international standards, norms and commitments. Recently, there has been a push for the World Health Organization (WHO) to facilitate the development and implementation of international legal frameworks to address trans-border health concerns. The International Health Regulations (IHR), which came into force in 2007, is one such legally binding agreement that aims to standardize disease surveillance, reporting and response among the 196 national governments who are members. Despite enthusiasm surrounding the potential for IHR to strengthen global response to infectious disease outbreaks, as of 2016, only 33% State Parties have fully implemented the IHR core obligations. The low levels of implementation points to the need to better understand the relationship between governments and these international institutions. In exploring this relationship we argue that geopolitical, cultural and economic factors are of paramount importance. Our study engages with international relations theory to understand the factors that shape IHR implementation in India. Our approach seeks to gain a local understanding of the relationship between India and the global political economy, the meaning India assigns to IHR commitments, and the notion of global health security more broadly. We will use a combination of qualitative interviewing and ethnographic methods to examine how decision-makers engage with IHR commitments.
Measuring progress towards the first UNAIDS’ 90-90-90 target in sub-Saharan Africa
Corresponding Principal Investigator: Mathieu Maheu-Giroux, Department of Epidemiology, Biostatistics, and Occupational Health
Co-PIs: Catherine Hankins, Department of Epidemiology, Biostatistics, and Occupational Health, and Shelley Clark, Department of Sociology
UNAIDS put forward the ambitious 90-90-90 target to end the AIDS epidemic by 2030. This target aims for 90% of people living with HIV (PLHIV) to be aware of their HIV-positive status, 90% of those diagnosed to receive antiretroviral therapy, and 90% of those on treatment to have a suppressed viral load by 2020. HIV testing remains an important bottleneck in this cascade, however, and obtaining reliable epidemiological data on the proportion of PLHIV aware of their status is difficult. Such information is nevertheless crucial to effectively monitor HIV prevention efforts. Tracking progress towards achievement of this “first 90” target could be improved by combining population-based surveys and programmatic data in a coherent deterministic/statistical model. This type of integrative systems modelling is especially useful to fully consider HIV incidence, mortality, testing behaviours, as well as to coherently combine different sources of data. We aim to produce validated yearly estimates of the first 90 in sub-Saharan Africa, where 2/3 of the world’s PLHIV reside. Our proposed framework has never been applied to this problem before and is an innovative way to answer a policy-relevant question that remains at the crux of the global health agenda.
Game of Zones: Transforming vector control mind sets and management skills to combat Aedes aegypti in Latin America
Corresponding Principal Investigator: Dr. Neil Andersson, Department of Family Medicine
Co-PIs: Dr. Cedric Yansouni, McGill University & Dr. Jorge Rafael Arostegui, CIET Nicaragua
A recent multi-centred randomised controlled trial published in the British Medical Journal demonstrated the unprecedented value of community-driven pesticide-free vector control in dengue prevention -- called Camino Verde(Green Way).
Based on this experience, successful control of zika, which shares the Aedes aegypi mosquito as its vector, needs several non-trivial paradigm shifts from conventional vector control logic and practice. The team behind Camino Verde proposes to support transformation of how the global community prevents, detects and responds to infectious disease threats through engaged game learning, resource allocation and motivational skill.
The Game of Zones is one of strategy, where the player or team tries to outsmart the epidemic, initially in a fantasy setting, increasing their understanding of community engagement and eco-zone dynamics. The second level of the Game includes speed and decision accuracy as key motivators. The third level introduces a vector control dashboard for simulation based on real data and standard budgetary allocation which can be linked to expected impact based on real meta-analyses of potential interventions and combinations of interventions. Mystery and surprise come in the form of new outbreaks, other agencies with competing strategies, and politically motivated decisions that can complicate prevention efforts in complex ways across different eco-zones.
Within the 18 months of funding, the Game game will be play-tested and deployed in educational initiatives in Nicaragua and Mexico. By the end of the project it will be available for use in other countries as part of a much larger international zika/dengue/chikungunya prevention initiative. A number of proposals for funding will hopefully extend its use and relevance in a number of international settings.
Game of Zones could have a considerable societal impact. Meaningful community engagement is fundamental for zika control and also relevant for anyone tasked with informing and motivating communities to prevent disease outbreaks or to reduce burden of disease. An interdisciplinary team will examine and test the relevance of the game for other infectious diseases similarly hampered by outdated paradigms of vertically managed disease control.
Early Detection of the spatial origin of infectious diseases allows the testing of hypotheses of emergence
Corresponding Principal Investigator: Dr. Colin Chapman, Department of Anthropology and McGill School of Environment
The devastating impacts that diseases like Ebola, the sudden appearance of diseases like SARS and Zika, and the immense social and economic costs created by viruses like HIV underscore our need to understand the factors determining the origin and spread of infectious diseases. Given that wildlife often share disease with humans and cause the emergence of may diseases, studying where people and wildlife interact is critical. After developing a phone based health reporting system for remote clinic, we will develop and field test the use of a mobile clinic established to build a union between health care and conservation to rapidly evaluate the disease emergence and test a series of hypotheses concerning factors that related to first occurrence and spread of emerging diseases.
A Pilot Study of Household Air Pollution, Oxidative Potential and Immune Function in South African Children
Corresponding Principal Investigator: Dr. Jonathan Chevrier, Dept of Epidemiology, Biostatistics and Occupational Health
Co-PIs: Dr. Jill Baumgartner, Institute for Health and Social Policy / Dept of Epidemiology, Biostatistics and Occupational Health & Dr. Scott Weichenthal, Dept of Epidemiology, Biostatistics and Occupational Health
Wood and other biomass fuel is used for cooking and heating by nearly half of the world’s population and by over 90% of the rural population in sub-Saharan Africa. The resulting household air pollution, and in particular fine particulate matter (PM2.5), is associated with a 3.5-fold elevated risk of acute lower respiratory infections, the leading cause of child death in sub-Saharan Africa. Further, exposure to PM2.5 causes systemic inflammation and oxidative stress, which may alter immune response to vaccines. Yet, few studies have 1) characterized exposure to PM2.5 in African children, or 2) examined the association of exposure to PM2.5 with immune response to vaccines or susceptibility to infection in humans. The Steinberg Fund will allow us to pilot instruments and protocols, and obtain preliminary data to support a larger grant application whose objective will be to fill these important knowledge gaps. Data will be obtained from a subset of South African children participating in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), a NIH/CIHR-funded birth cohort study of 751 mother-child pairs. This study has wide-ranging implications given the high disease and mortality burdens caused by infectious diseases in children from areas where biomass is used.
The mental health of internally displaced youth in the state of Jammu and Kashmir
Corresponding Principal Investigator: Dr. Jai Shah, Douglas Hospital Research Center
Co-PIs: Jitendriya Koul, MBBS, Jagti Medical Center & Jaswant Guzder, MD FRCPC, Jewish General Hospital
Mental disorders, most of which originate in youth, are major contributors to disability, morbidity and mortality. They are also precipitated and exacerbated by violent conflict, which in turn reduces access to much-needed care – particularly in the developing world. In this project, we will better understand youth perceptions of mental health (and the varied influences on it) in the Jagti township of ethnic Kashmiris who were forced to leave their ancestral homelands following the 1990 conflict in Jammu & Kashmir. We will engage local stakeholders and guide community-based efforts (led by lay health workers and assisted by mobile technologies) to identify untreated cases of major mental disorders (psychotic, bipolar and depressive disorders). In the context of meager mental health services and stigma, we will then begin providing youth (aged 15-35) and their families with appropriate mental health services through partnerships with local psychiatrists. The project aims to increase awareness of mental illness and receptiveness to its care, including within local community organizations in Jagti. More broadly, it will identify and highlight the mental health needs of internally displaced populations: a neglected and growing challenge yet to be addressed in global mental health.
Building Capacity for Non-Communicable Disease Care in Pregnancy in Haiti
Corresponding Principal Investigator: Dr. Julia von Oettingen, McGill University Health Centre, Montreal Children's Hospital
Co-PIs: Louise Pilote, McGill University Health Centre, MGH & Kerling Israel, Hopital Universitaire de Mirebalais / Partners in Health
Despite high prevalence estimates of diabetes and hypertensive disorders in pregnancy in Haiti, including postpartum cardiomyopathy (PPCM), these conditions remain vastly unrecognized. Access to adequate gestational screening remains limited.
The goal of this project is to improve maternal and infant health and prevent the intergenerational transmission of non-communicable diseases (NCD) by addressing major pregnancy-related NCDs.
We designed a cross-sectional study to screen for diabetes, hypertension and PPCM in 650 pregnant women in Haiti’s Artibonite region. Participants will be enrolled from a local antenatal care (ANC) clinic in the catchment area of St. Nicholas Hospital in St. Marc. The study’s longitudinal cohort arm will assess health outcomes in the pregnant women detected to have one or both conditions, and in their offspring.
- To obtain an accurate estimate of the prevalence of hypertensive disorders and diabetes in pregnant women who visit an ANC in Haiti.
- To gain knowledge about the feasibility of implementing a screening protocol, establish setting-adapted screening and treatment strategies, and document outcomes of these pregnancy-related NCDs.
- To validate a screening questionnaire for postpartum cardiomyopathy (PPCM).
- To transfer knowledge about research protocol design, research conduct and data interpretation.