Tamara Jimah, a postdoctoral fellow at the UCI Sue & Bill Gross School of Nursing, is the university’s first trainee to be chosen for the prestigious University of California Global Health Institutes GloCal Health Fellowship.
She answered a few questions about her study, Promoting Women’s Health in South Africa: Enhancing TB Treatment Adherence among Female Patients with TB and HIV/TB Coinfection, and how her UCI mentors have been instrumental to her success.
Why is South Africa a TB hotspot?
South Africa is among the top 10 countries contributing to the global burden of Tuberculosis (TB).
This high burden is driven by several factors, including low socio-economic status, delay in seeking care which leads to undiagnosed infections, as well as low health literacy, which may result in early discontinuation of treatment or non-adherence to the TB treatment regimen prescribed by the doctor.
More recently, the health system has been overburdened by the COVID-19 pandemic, decreasing access to health services and posing a challenge to TB control efforts.
For instance, TB testing has declined as the fear of contracting the virus prevents patients from seeking care.
Another key reason is the country’s high HIV/TB co-infection burden. HIV weakens the immune system, making it much harder for one’s body to naturally fight off infections.
Why is TB/HIV co-infection so prevalent there?
Over 10% of South Africans are living with HIV. HIV and TB are closely interconnected; HIV is a major driver of TB and TB is the leading cause of mortality among people living with HIV. Hence, these infections cannot be fully studied in isolation.
Furthermore, stigmatization of the infection causes shame and guilt and prevents patients from seeking care to initiate treatment at the early stages. E
Even in cases where patients initiate treatment, the persistent social undesirability surrounding TB and HIV frequently results in loss to follow-up or non-adherence to the prescribed regimen. This consequently gives way to drug resistance and further complicates treatment efforts.
What cultural/societal factors impact women and their TB infection rate?
Women are particularly impacted due to gender-based inequities, low literacy rates, and limited financial autonomy. For example, given their typical role as primary caregivers, women face a higher risk of exposure from caring for family members with TB.
Also important to note is that among women with TB, those living with HIV may face additional barriers due to HIV-related stigma. There exist other barriers to treatment which I hope to better understand through my research.
During my fellowship, I’ll use ecological momentary assessments to identify these unique factors.
What factors in the ecological assessment will you be evaluating?
An area of interest is the problem of non-adherence to TB treatment, i.e., when patients fail to complete the required course of treatment.
I’ll be working with well-established researchers at the Desmond Tutu Health Foundation to identify the different psychosocial and contextual factors that influence patients’ adherence to treatment.
To do this, we will integrate ecological momentary assessments (EMAs) with a medication monitoring device (Wisepill) to explore real-time and near real-time factors influencing adherence.
The Wisepill, an internet-enabled medication dispenser, allows us to remotely monitor patients’ adherence in real-time, while the EMAs allow us to capture patients’ self-reports related to their treatment adherence behaviors.
How have professors Sanghyuk Shin’s and Yuqing Guo’s mentorship prepared you for this opportunity?
Immensely! I owe my preparation for this next stage in my career to [Associate Professors] Yuqing Guo and Sanghyuk Shin.
Actually, my current postdoctoral work with Dr. Guo shares some elements with the research I’ll be engaged in in South Africa, specifically, the EMA component. This was one reason I was drawn to apply for the fellowship.
Dr. Guo’s passion, curiosity, knowledge, and kind mentorship these last couple of years have been inspiring. My current postdoctoral work with Dr. Guo shares some elements with the research I’ll be engaged in in South Africa, specifically, the EMA component. This was one reason I was drawn to apply for the fellowship.
I’m also especially thankful to Dr. Shin for his encouragement and support during my fellowship application and his continuous knowledge sharing. Dr. Shin’s expertise and extensive experience in TB research in southern Africa is an extremely valuable resource and I’m excited to have him serve as the primary mentor for my GloCal fellowship.
How has UCI and UCI Nursing prepared you?
I’m incredibly grateful to have had a wonderful learning experience here at UCI. I completed my PhD in the Department of Population Health and Disease Prevention with the guidance and exceptional support of my advisor and professors.
Also, my current postdoctoral work at the UCI School of Nursing has been enriched by our collaboration with the Department of Computer Science and highlights the critical role of interdisciplinary research. All of these opportunities have reinforced my interest in implementation research. I look forward to gaining further knowledge and skills during my upcoming fellowship.
What led you to this area of research? Why is it important to you?
I’ve lived in the US for almost a decade. Before that, I lived in Ghana, where I spent most of my childhood. Growing up in Ghana, I witnessed the challenges and distinct disparities driven by poverty and place of residence, and how these frequently predicted one’s state of health. My research interests and passion for global public health have been influenced by these experiences.
Tuberculosis is preventable and generally curable with the right antibiotic treatment regimen, however, it remains a major cause of morbidity and mortality. It is devastating to lose a family member or friend to a preventable infection, particularly with the current medical advances. By collaborating with expert researchers and practitioners, I hope I can be a part of the effort to reduce the global TB burden.
Study abstract
Project Title: Promoting Women’s Health in South Africa: Enhancing TB Treatment Adherence among Female Patients with TB and HIV/TB Coinfection
Summary: The global Tuberculosis (TB) burden is concentrated in low and middle-income countries, is heavily influenced by social determinants of health, and continues to be a leading cause of global morbidity and mortality. South Africa is among the top 10 countries contributing to the global burden of TB and has the highest prevalence of TB/HIV coinfection. Women are particularly affected by TB due to existing gender-based inequities, low literacy rates, and limited financial autonomy. Given the importance that gender plays in an individual’s health behavior, understanding the unique burdens that women face relating to medication adherence and factors associated with treatment lapses is central to developing gender-responsive interventions to improve TB treatment adherence. The aims of this research study are to 1) Conduct a pilot study among female TB patients living with and not living with HIV using the integrated Wisepill medication event monitoring system and modified ecological momentary assessments to collect data on real-time and near-real-time factors that influence their TB treatment adherence, and 2) Examine variations within and between TB patients living with and not living with HIV to determine factors that influence women’s adherence to TB treatment.
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