second quarter april - june 2019

At the helm of the PEER Cervical Project: Clinical Story Research Site on Leader Dr. Lameck page 2 Chinula. File photo Cancer Screening Right: A cross section of delegates during the launch. and Preventive Therapy Project launched UNC Project continues to fight cervical cancer, a leading cause of cancer related deaths in .

‘Perception of cancer has changed, just like it happened with HIV,’ Dr. Satish Gopal

lot of community awareness innovation in the treatment of cancer. on health care and research. has significantly contributed However, he said, cancer care is still “In 5 to 10 years, it will be exciting to Ain helping people understand centralized in Malawi just like other have been part of the contribution in the more about cancer, a non-infectious countries which makes it harder for treatment of cancer in Malawi,” said the disease involving abnormal cell growth some people in distant locations to access oncologist. which usually invade or spread to other diagnosis and treatment. Situated at UNC Project Malawi, parts of the body. “At least decentralizing screening The Malawi Cancer Consortium was Speaking recently to a team of services would help. Pathology, established in 2014 to develop capacity student journalists from UNC – Chapel chemotherapy and screening are highly and conduct high-impact research Hill, Director of the Malawi Cancer centralized. There is also need for more focused on HIV-associated cancers, with Consortium Dr. Satish Gopal, said training of personnel to carry out all support from the NCI Office of HIV/ establishing of diagnostic facilities, these roles,” he explained and added AIDS Malignancies. courtesy of UNC Project has helped in that Malawi has few pathologists and In 2016, additional support was achieving this. oncologists. provided by the NCI Center for Global “People’s perception of cancer has UNC Project, according to Gopal, has Health to establish a Regional Center of changed just like it happened with been the centre of processing samples Research Excellence for NCD. HIV,” he said adding that cancer is a and interpreting samples from across The consortium builds on topic the consortium is working on Malawi and has also taken a big role in longstanding collaborations between the through various studies ,and research the coming of the cancer treatment centre University of North Carolina at Chapel continues to grow. in . Hill, Lighthouse Trust, Malawi Ministry On the issue of vaccination for UNC has a 15 strong faculty member of Health, College cancer, Gopal said researchers are team doing various assignments in of Medicine, Kamuzu Central Hospital, Dr. Satish Gopal. File photo: making big efforts to bring a lot of Malawi with a strong leaning and other partners.

Twambilile Phanga ACTG thanks CAB represents Malawi Imbokodo: One year later 2 members for their 3 in WHO Innovation 5 contribution Challenge 12 TIDZIWE POST SECOND QUARTER 2019

Delegates during the launch of the Peer Cervical Cancer Screening and Preventive Therapy Project at the Bingu International Conference Centre. Photo: Callisto Sekeleza War against Cervical Cancer stepped up NC Project Malawi on Thursday, April 4, Speaking during the launch, National 2019 was part of the launch of the PEER Coordinator for Cancer Services Twambilile Phiri, Cervical Cancer Screening and Preventive said Malawi government also felt compelled to UTherapy Project, a new study funded by the United curb the cervical cancer burden, saying there were THERMOCOAGULATION States Agency for International Development strategies in place to help achieve this. Among (USAID) and National Academies of Science these, she mentioned HPV vaccine which was Thermocoagulation uses heat to destroy tissue (visible (NAS), which will be led by the University of being rolled nationally, screening programme in precancerous lesions). The superficial epithelium blisters off North Carolina (UNC) at Chapel Hill and the all district hospitals for women aged 25-49 years, after treatment, and the underlying stroma and glandular University of Malawi – College of Medicine. scaling up cryotherapy and spreading of research. crypts are destroyed by desiccation. Other partners in the consortium are MSH, According to UNC Project Malawi Clinical The maximum temperature during thermocoagulation is the Malawi Polytechnic and the University Site Research Leader Dr. Lameck Chinula, the 120°C to control of post-LEEP bleeding. of Washington. The study will evaluate the cancer study is designed as a cluster randomized The technology has a clinical appeal because it is user- feasibility and cost-effectiveness of integrating trial integrating HPV-based screen-and-treat friendly, inexpensive, and durable. The system runs entirely on a human papillomavirus (HPV)–based cervical algorithm with voluntary family planning (VFP) electrical power and requires no gas to operate. The treatment is cancer screening and treatment approach with services. fast, easy to learn and the equipment has a low dependency on voluntary family planning. Sixteen health facilities There are two models which will be applied a service infrastructure. in Lilongwe and Zomba will participate as study in the study: In model 1 which will be done at The treatment requires generally no local anaesthesia and is sites. the clinic only, there will be cervico-vaginal self- administered within a very short treatment cycle (< 2 Minutes). In a statement during the launch, USAID said sampling for rapid high risk – human papilloma The device is fairly simple to use and does not require long Malawi had the world’s second highest incidence virus (hr-HPV) testing using the GeneXpert enduring and costly training for an operator to understand how of cervical cancer. machine. On the same day, thermocoagulation it is done properly. “These deaths can largely be prevented will be conducted to treat the women found Published data shows that cold coagulation treats cervical through regular screening for, and timely positive. lesions as well or better than cryotherapy. treatment of precancerous cervical lesions. This In the second model (Clinic + Community), is due in part to limited resources and health similar procedures will be followed but the facilities that provide screening programs, as difference will be that the self-sampling will be (https://www.thermo-coagulation.com/) well as a shortage of medical providers trained to done at home and not at the clinic as in model 1. perform the necessary diagnostic and treatment Thermocoagulation will also follow if the women procedures,” read the statement. are found to be hr-HPV+.

This is an in-house publication. Its mission is to promote a sense of community by communicating information relevant and vital to the operations and staff of UNC Project Malawi. In a drive to increase participation and bring variety to the publication, all UNC Project staff are free and encouraged to contribute articles in this publication. Write ups ar wlecome in the range 400 – 600 words for event stories and a maximum of 1000 words for other more technical issues worth sharing.

Forward your contributions to: [email protected]

Graphic layout: Thank you for contributing to ACTG studies The Aids Clinical Trials Group (ACTG) recently recognized role of the community advisory board (CAB) of UNC Project Malawi, in the studies under the Group, through award of certificates of appreciation. The CAB consists of various people Communications including participants in clinical trials; traditional, civic, religious and political leaders and representatives of groups with special needs such as women and youth. IN THE PHOTO: Country Director Innocent Mofolo and UNC Project staff pose together with the CAB members after presentation of certificates. Photo: Callisto Sekeleza TIDZIWE POST SECOND QUARTER 2019 13

WHO Innovation Challenge picks 30 out of 2400 entries for the 2nd African Health Forum Twambilile represents Malawi in Cape Verde wambilile Phanga’s ‘Youth Friendly Health Services’ was among the 30 Tbest-profiled innovations during the three-day World Health Organisation (WHO) 2nd Africa Health Forum which took place in Cape Verde from 26-28 March 2019. According to the WHO regional office for Africa, the WHO Innovation Challenge received a total of 2 471 applications in just four weeks from 77 countries – 44 countries in Africa. A panel of independent evaluators assessed and profiled the innovations in terms of the potential for making impact as well as ability to be scaled up in a sustainable way. More than a third of the submissions came from women. “In the WHO Innovation Challenge, the idea was that the chosen innovations that can help solve African health problems, would be given chance to go to the Africa Health Forum in Cape Verde to exhibit in front of worldwide donors, government officials to see what other people were doing in Africa,” explained Phanga said who is UNC Project’s Project/Study Coordinator.

Journey on Phanga said following the Cape Verde Cape Verde president Carlos Almeida Fonseca and WHO Regional Director for Africa Motshidiso Moeti interacting with event, WHO has written all the 30 people Twambilile. Photos: Courtesy of organisers who participated in the Challenge to contact their home (WHO) offices so that services but we were only in one clinic in that I presented was that in Malawi we effective in increasing uptake and the innovations should not be forgotten. Malawi. We feel if they fund us, we can have high rates of teenage pregnancies, adherence to sexual and reproductive “In the submission, we told WHO be in almost every health centre or every and also high rate of HIV infections health support and services. The that we had this study which had district. We believe these services can among the adolescent girls and young programme provides services from amazing results in terms of uptake of effectively reduce pregnancies as well as women. This is largely because they a young person’s perspective and sexual and reproductive health HIV infections cannot access services at a normal addresses known barriers to care in among the clinic. When they go there they meet youth dedicated spaces, separate from youth,” she judgmental providers. The timing of the said. services is wrong, sometimes there are adults. Providers are trained in the She added stock outs and many other challenges. YFHS approach to improve attitudes and that they also “Through ‘Girl Power study led by peer educators are used to help young convinced the Norah Rosenberg, we implemented clients navigate health services as well as WHO that this four models of care whereby young provide free services. was a model adolescent girls and women could come which could be and access sexual reproductive health More power implemented in services,” she said. Following the ‘Girl Power study’ which resource-limited The study compared three clinics that was being supported by UNC Project, settings, and offered a model of youth friendly health the Youth Friendly Health Services it was a model services to one that did not. Participants (YFHS) project run as a pilot project that the rest of were followed for one year to monitor under the banner ‘Mphamvu’ at Kawale Africa could uptake and adherence to services. The Health Centre from September 2018 to learn from. results were 97% HIV testing, 82% February 2019 with funding from Unicef. condoms, and 54% contraception uptake, Soon the services will also be extended The problem compared to the low numbers from the to Mitundu Health Centre, a facility highlighted clinic that did not offer the services. about 36 km away from the UNC Project “The problem The YFHS model proved to be Tidziwe Centre.

Twambilile together with some key members at the Kawale Health Centre Youth Friendly Health Services. File photo 4 TIDZIWE POST SECOND QUARTER 2019

The four HSL librarians with UNC Project Asscoiate Country Director Debbie Kamwendo (left), Library Associate Wongani Jumbo (centre) and Country Director Innocent Mofolo. Photos: Callisto Sekeleza our librarians from the University of North Carolina (UNC) at Chapel FHealth Sciences Library (HSL) visited UNC Project Malawi from 3rd to 7th April 2019 to do a needs assessment Carolina visits Malawi and determine how they can support and partner with libraries, researchers, specific issues and how best they could Jumbo to strengthen their working and publications,” said UNC Project students, and clinicians in Malawi. be assisted through partnership with the relationship. They also donated three Library Associate Wongani Jumbo. The four were: Dr. Nandita Mani Health Sciences Library. books to the library. They also promised Jumbo said the Project’s library will (Associate University Librarian - HSL On the 5th, the visitors met with the that HSL will support the project’s library benefit from the visit by the four through and Director), Michelle Cawley (HSL Hospital Director of Kamuzu Central in every way possible in order to improve having access to most library materials Head of Clinical, Academic, and Research Hospital Dr. Jonathan Ngoma. A working its service delivery to staff and the entire Engagement), Rebecca McCall (Clinical partnership was established between community around KCH. from HSL like books, among others. Librarian), Megan Fratta (Community KCH and HSL. The visitors also donated “The four also visited the Malawi “UNC Project staff will benefit from Outreach and Global Health Librarian). three books to KCH library through College of Health Sciences and Kamuzu this visit in that they can work with the On the 4th, the guests had a tour of the the office of the Hospital Director. The College of Nursing libraries. In both HSL team directly on different research project’s facilities at Tidziwe and Annex visitors toured the hospital and later libraries, the visitors met with librarians projects, a thing which was previously buildings. This was facilitated by the donated assorted items to the paediatric and working relationships were also not possible. The team will be able to help Associate Country Director. On the same department. established. The partnership would day, the visitors met different members The visitors also spent some time with include collaborating in writing grants staff with systematic reviews and other of staff to hear from them on faculty UNC Project Library Associate, Wongani and also on different projects like research research related works,” said Jumbo.

For love of the camera UNC School of Journalism students, Margaret (Left) and Emily (Right), were also in country documenting for the print and electornic media platforms at Chapel Hill. This was part of their academic assessment. In the photo children at the school sponsored by UNC Project at Dzama, could not have enough of the video and still photos that had aldredy been taken of them. TIDZIWE POST FIRST QUARTER 2019 5 ‘There have been myths and misconceptions about the HIV vaccine’ IMBOKODO ONE YEAR LATER

year down the line, since the HVTN 705 (Imbokodo) study Aenrolled the first participant, the last entrant was expected to be enrolled in May, making 154 the total number of participants allocated to the Lilongwe trial site. Upon enrolment, all participants are followed separately for the next three years to ascertain if the HIV vaccine is safe and effective. The Imbokodo study is happening in Malawi alongside other countries in southern Africa namely: . , and South Africa with a total enrolment of 2600 participants. HVTN 705 has total of 26 sites in all the countries, with many centres located in South Africa. The study is investigating if two HIV vaccines administered can prevent HIV negative women of the age range 18 – 35 from getting HIV. According to HVTN 705 Co- Investigator Dr. Terence Tafatatha, participants in this randomized, double- blind and placebo-controlled study will receive 6 vaccinations at four time points. “We are experimenting two HIV vaccines to see if they can prevent HIV in women in Sub- Saharan Africa. First vaccination is done at enrolment, then after three months and again after another three months (six months from enrolment) with the last one after six months (1 year from enrolment),’ said Tafatatha, adding that at 6 and I year Lighter moments: Some of the staff at the George Joaki Centre relaixing. Photos: Callisto Sekeleza points the participants will be getting two vaccines at one go. He said the major criteria for we are giving HIV to people and not positive results when a person undergoes study. enrolling participants were: women of a vaccine. Others would think we are a rapid HIV test. Women are the most affected by age 19-35, HIV negative, healthy, not encouraging people to go and get HIV,” “When we are consenting these HIV, and Tafatatha said if this Phase pregnant and not breastfeeding. he explained. participants to enroll, we give them all II B vaccine trial achieved desired Tafatatha said upon clocking Apart from such this information so that they can know results, women would be its primary one year, all has not been all misconceptions, Tafatatha that once we give the vaccine, it can beneficiaries. rosy in the enrolment of study also said there was also induce antibodies which can lead to HVTN 705 is a collaboration between participants. lack of understanding positive results when a rapid HIV test the HVTN and Janssen Pharmaceuticals, “There have been myths on how vaccines is conducted. So if they want to do an designed to test an HIV preventive and misconceptions about work especially with HIV test, they should come to the clinical vaccine regimen that covers the different regards to VISP – site for an HIV DNA test or we shall the HIV vaccine. Some types of HIV found across the world. For people would think that vaccine induced sero- recommend where else they can go,” he positivity. This when explained. Southern Africa, the study was named the vaccine produces He also said there were “Imbokodo”, an isiZulu word meaning antibodies for HIV upon misconceptions regarding drawing of “rock” and coming from a popular receiving a vaccine, blood for various tests. However, he said African proverb which says, “Wathint’ a thing which the team at the centre has done its best to Abafazi, Wathint’ Imbokodo!” (“You Strike can produce clear such barriers to the progress of the the Women, You Strike the Rock!”

Co-Investigator Dr. Terence Tafatatha. Inset: George Joaki Centre. 6 TIDZIWE POST FIRST QUARTER 2019

Palliative care staff trained by the Ndi Moyo Palliative Care Trust with UNC Project officials. UNC Project hosts Ndi Moyo Palliative Care trainees ighteen Health professionals who According to one of the facilitators that they can appreciate the role that the Malawi, UNC came into the loop because were undergoing specialized of their tour at UNC Project, Esnath Project is doing. We have been doing this of the role it plays in the health sector. Etraining in palliative care under Mkandawire, this was the fifth time that in all the past visits that Ndi Moyo has Palliative care seeks to improve quality the Ndi Moyo Palliative Care Trust from the Ndi Moyo Palliative Care Trust has requested us to host their trainees,” she of life for both chronically ill patients and Salima visited UNC Project - Tidziwe sent people undertaking its trainings to said. even for the affected family. Centre - on 22 March 2019. This was come and visit facilities at UNC Project. She said initially such trainings were The Ndi Moyo Palliative Care Trust part of their familiarisation with some “During such visits we take the people normally being done in Uganda but establishments which provide various around all the facilities at UNC Project runs a centre in Salima district, providing since they started administering them in services in the health sector of Malawi. especially the clinic area and the labs so palliative care across the district.

UNC labs THINK big Bacterial sequencing on the cards

UNC labs want to grow their capacity with bacterial whole genome sequencing. The technology has the potential to provide in one single step, nearly all the information required to detect and characterize bacteria, to carry out antimicrobial resistance testing, to identify virulence determinants, and ultimately inform public health measures. The sequencing technology requires staff to have skills to handle all the protocols involved. In early April 2019 some UNC staff had hands on training in this field of microbiology. Lab director Gerald Tegha recently told the general staff meeting that the Project wants ‘to grow capacity of the laboratories’ with such technologies. Photos: Callisto Sekeleza TIDZIWE POST FIRST QUARTER 2019 7 PICTORIAL FOCUS

Simone Sasse and Annie Thom: Perceptions And Alleviators Of Hiv Stigma Amongst Victoria Youngblood: A Prospective Study Of Breast Cancer At A National Teaching Women On Option B+ Treatment In Lilongwe, Malawi. Hospital In Malawi.

Jennifer Kincaid: Mortality Of Mass Casualty Incident Patients Presenting To Kamuzu McNeili Ngongondo: Bone Mineral Central Hospital. Density In Malawian Women At 1 Year Post Partum. 2019 Research Dissemination

he afternoon of Friday 26 April was exciting and educative when an attentive audience grasped contents of 7 presentations making the 2019 UNC Project Scholar Research TDissemination. The presentations hinged on the following topics: Bone Density, Breast Cancer, Hiv, Trauma And Pneumonia.

Zachary Smith: Validation Of Digital Auscultaion And Computerised Lung Evarista Kudowa: Incidence Rate And Predictors Of Hiv Incidence Among Adolescent Software Analysis In The Evaluation Of Pneumonia In Malawian Children: Girls And Young Women In Lilongwe, Malawi. A Preliminary Report.

Laura Limarzi: Influences Of Male Partner Support On Perinatal Depression Symptoms Among Women Enrolled In Option B+ In Malawi: A Qualitative Analysis. The presentors and their mentors after the day’s work. Photos: Callisto Sekeleza 8 TIDZIWE POST FIRST QUARTER 2019

UNC project people

Welcome to the column. Please tell us how your journey with UNC Project has been like. Joyce Chiulika Chagwada I started working with UNC Project on 25 April 2005 and stayed up to 7 May 2007. I started out as clinic aide for the Breastfeeding and Nutrition (BAN) guest house keeper study. That was also the time when the keeper up to April 2009 when I was Isn’t the work too much for you? UNC Project guest house was being promoted to guest house keeper after my No. Like for the personal laundry, the constructed. While I worked as clinic boss resigned to join politics. room occupants do it on their own while did one term of class 7 and again we aide, management was already aware we just take care of the beddings. We moved to Blantyre where I completed that my career was in cooking and When you say housekeeping, what does also plan properly on the tasks to be my primary school at Chirimba Primary housekeeping. Before starting work your work involve? done both for the old guest house units School. My father used to work for at UNC Project, I already knew some When we talk about housekeeping, it’s and the new ones. We have washing International Red Cross Federation. personnel while the organisation was about receiving and machines in both In 1993 I was selected to Stella Maris being housed in Amina House (opposite taking care of the buildings. Secondary School where I did Forms 1 Cashbuild). By then I used to work at guests. This involves up to 4 in 1997. I did not do well in my Mona’s Take Away which was in the cooking, cleaning What work related school certificate. My family had also same complex as UNC Project. That’s The guests are adults and that rooms, making the challenges do you moved to Lilongwe where I wrote the UNC Project management were aware beds, taking care of makes it easier to work with face? exams again in 1998. of my real career from interactions at laundry and many them. They are ready to talk to You know we In 1999 I started working at Public Amina. “ Affairs Committee (PAC) as the country more. We also brief are working with When the UNC Project guest house them some issues us to deal with any issues they different people was preparing for that year’s elections. was completed in 2007, that was when concerning their stay may have. from different I worked as elections monitor. While my name was recommended to move in Malawi like how countries and working there I also joined cookery from the BAN study and assist at the they can conduct themselves in some cultures. Some understand us while training at the Malawi Institute of guest house. By then my supervisor was places. We also tell them things like our others do not. Sometimes, others are Tourism. I was trained for six months. late Godfrey Kamanya. culture. not willing to live by the guest house In 2000 I stopped working for PAC and I worked as assistant guest house guidelines, a thing which may make our joined Mona’s Take Away as supervisor. Up to how many guests do these work difficult. I worked from 2000 up to 2003. In 2005 I facilities at the Project accommodate? joined UNC Project. Usually during summer (US), from May What are the things you cherish in your I am married with one child. My son to August, we have many guests. Almost work? is turning 19. in every room we have two guests The guests are adults and that makes sharing. We can have up to 30 guests. it easier to work with them. They are What do you like to do outside your ready to talk to us to deal with any issues work? So do you cook for all that big number they may have. They are lovely people I like watching television especially or they cook for themselves? and are ready to help even in personal gospel channels. I like praying a lot. Of course they cook for themselves but problems. Sometimes they even bring sometimes they involve us to prepare us all together with our families just to In your general life, what are your food for them. interact. We stay as one family. highest and lowest moments? My highest moment was when I heard What’s the lowest number of guests So in the past 12 years what is it that that my son had been selected to study within a year? you will cherish most about UNC at MUST and the assistance he is getting The lowest number we can have within Project? until he completes his BSc in Medical a year is from eight to ten guests. As of In 2008, when the Hoffman’s came to Microbiology at the university. I will now there are seven guests but come Malawi, I also had training facilitated by live to cherish this. I really enjoyed and summer we should receive more guests. Mrs. Hoffman in catering. The training I worship God for that. I am always was done right here at the guest house praying for my bosses for the support. How many staff are you at the guest and later I got certificate from UNC. This One of my lowest moments was house? certificate raised my professional acco- when I heard that my former guest We are three. I have my assistant and we lade and I can be rated highly anywhere house supervisor Godfrey Kamanya had also have one gardener. We also have else. It was written ‘from University of committed firearm suicide. I feel bad two guards during the day and three North Carolina.’ every time I remember about that and during the night. what his dependents are going through. Having learnt about your work related background, what would you want Lastly in this interview what would you us to know about your personal want to say? background? I always thank UNC Project Malawi I was born Joyce Chiulika management; Mr. Bonomali, Mr. Mofolo on 25 July 1975 in Blantyre. I did my for their understanding. Sometimes we primary school at do wrong things but they correct and Blantyre Girls Primary guide us. I always pray for their families. School. From there I also thank the guests here for their we moved to Dedza understanding. I am forever grateful to where I did classes 6 the Hoffmans for their support. I also and 7. Then we moved cherish all the staff I supervise at the to Ntcheu where I just guest house.

UNC Project People will be a regular feature in each issue of the Tidziwe POST. Do you know someone with anything interesting or unique at UNC Project? Please email your suggestions to [email protected] indicating name and department the individual is working in.