CARIBBEAN ISLANDS. Name: Luisa T. Krug. Degree and Year: Chemistry and Molecular Biology Oklahoma State University, 2011

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1 CARIBBEAN ISLANDS Name: Luisa T. Krug Degree and Year: Chemistry and Molecular Biology Oklahoma State University, 2011 Integration of human papilloma virus vaccine distribution into currently existing Notre Dame Haiti Program mass drug administration programs Human papillomavirus (HPV) is the main causative agent of cervical cancer and can also cause other cancers in men and women such as vaginal, penile, and oropharyngeal cancers. Although the implementation of screening and vaccination programs has lowered the incidence and mortality in the developed world, a lack of these resources in the developing world has led to cervical cancer disproportionately affecting low and middle-income countries. Therefore, the WHO now recommends the addition of the human papillomavirus vaccine into routine national immunization schedules and organizations are advocating for increased prevention programs worldwide. This project discusses the feasibility of the integration of a Human papillomavirus vaccine distribution program into the Notre Dame Haiti Program s existing mass drug administration program (MDA). The Notre Dame Haiti Program does an annual distribution of medications for Lymphatic filariasis, a mosquito borne disease that affects over 2 million Haitians. These medications are distributed free at posts set up within each community across the country. Feasibility was evaluated through community interviews and focus groups with participants from the following populations: parents, community members, and health workers and administrators. This research was focused in the Ca Ira community of the Leogane commune, but also took place in the communities of Diclo and Carrefour. Although initial knowledge of HPV and cervical cancer was low, participants were in favor of the implementation of this vaccine program within MDA, due to an acceptability of vaccines in general, and due to the respect that the MDA program has within these communities. In addition, interviews with health workers showed several logistical challenges but most employees agreed that good planning could create effective and feasible solutions for all of these challenges. After evaluating the evidence gathered, it is proposed that the HPV vaccine be distributed at MDA posts to boys and girls ages in a pilot project in the Leogane commune. The second and third doses of the vaccine would be given at schools and local health centers within the communities targeted for the pilot project. This would be preceded by an extensive educational campaign that includes community seminars and HPV screening for women. Following the evaluation of the pilot project, an informed decision can be made about increasing the scope of this project.

2 Name: Annette Ruth Degree and Year: Psychology and Biology University of Notre Dame, 2011 Evaluating the efficacy of cholera prevention programming at changing PU BUC sanitation and hygiene behaviors in Haiti: Implications for control strategies, surveillance, and public policy Evaluations of Catholic Relief Service's (CRS) post-earthquake cholera education programming in Haiti were conducted in June 2011 and March 2012 to evaluate the efficacy of their social marketing efforts for cholera prevention. A Knowledge, Attitudes, and Practices (KAP) survey implemented throughout Haiti collected data that was used to assess changes in beneficiaries' cholera prevention behaviors, their access to essential prevention and treatment materials, and time to seeking treatment. Thus, the purpose of the KAP was to determine the extent to which project beneficiaries have adopted improved hygiene and sanitation practices as a means of gauging the effectiveness of behavior change communication (BCC) and cholera messaging supported by the project. Furthermore, the KAP evaluation measured percent change in knowledge, behaviors, and practices between the 2011 evaluation results, serving as a partial baseline for the study, and the 2012 KAP survey to determine how well households adopted cholera prevention behavior. The main results of the study indicate that weaknesses in sanitation and hygiene practices and poor knowledge of cholera transmission have led to the persistence of cholera outbreak in Haiti. Comparing the results of the 2012 survey to the 2011 baseline found that the percentage of people who did not know how cholera was contracted increased by 22% (95% CI), comprising 59.5% of total respondents. Similarly, the percentage of people washing hands after using something touched by others, or potentially contaminated, decreased by 15% from the baseline, corresponding with poor knowledge of transmission via fomites. Open defecation decreased from 20% in 2011, though not significantly. However this data was likely confounded by the fact that a significant number of non-governmental organizations (NGOs) removed operations in Haiti, reducing handouts, resources, and informative, educational messaging given to the public. Considering that cholera spreads primarily via environmental contamination and not direct, person-to-person contact, the need for behavioral programming grows. Prevention strategies, such as behavior change programming, are necessary in countries like Haiti, where poverty, poor infrastructure, and a lack of sanitation facilities necessitate changes in routine behavior to prevent outbreak. Consistent surveillance and the implementation of environmental health assessments at outbreak sites can be used to create targeted, community-specific intervention programming.

3 Name: Noelle Tripp Degree and Year: BA Sociology and Preprofesional Studies University of Notre Dame, 2011 Expanding preventative service delivery in Haiti Currently, the country of Haiti is suffering from a two-year long cholera outbreak as well as mosquito-borne illness. Preventative measures such as the cholera vaccine and insecticide treated mosquito nets could help decrease the incidence of disease throughout the country. Existing programs that have the capacity to achieve national coverage, like the Notre Dame Haiti Program s mass drug administration, could serve as the vehicle needed to deliver these two services. This study evaluates the feasibility and acceptability of carrying out such a project through interviews and focus groups with community members from Ca Ira, a semi urban community in Leogane, in addition to conversations with healthcare workers. Comparison studies were conducted in the rural village of Diclo and the urban borough of Carrefour. The data collected from these discussions demonstrates that community members would be receptive to incorporating additional services into the mass drug administration. However, contributions made by healthcare workers highlight that a number of logistical challenges must first be addressed. Through a proposed pilot study, the Notre Dame Haiti Program will be able to test the practicability of integrating new services into the existing structure of the mass drug administration program.

4 Name: Shannon Cawley Degree and Year: Chemistry and Biochemistry Western Connecticut State, 2010 Helicobacter pylori in Haiti: An initial evaluation of potentially effective diagnostic antigens and health care professionals knowledge for use in future public health programs Helicobacter pylori is a common bacterium that colonizes the gastric mucosa. It has become an important public health issue because of its association with serious diseases like gastric cancer and gastric mucosal-associated lymphoid tissue (MALT) lymphoma. The prevalence of H. pylori is much higher in developing countries, like Haiti, where the socioeconomic conditions are poor. Therefore, reduction of H. pylori prevalence and incidence in Haiti will require many years of work. One essential component of an H. pylori initiative is an affordable and effective diagnostic tool. A serology multiplex assay designed by the Centers for Disease Control (CDC) is one such tool, but it needs to be designed to detect H. pylori specific antibodies. A significant literature review was conducted to identify H. pylori antigens that have the potential to accurately diagnose H. pylori positive individuals. In addition a small group of patients were enrolled in a pilot study to determine their H. pylori status for use in the initial evaluation of the multiplex assay, once it has been developed. It is also critical to evaluate the current clinical practices of local health care providers to ensure that patients are receiving the appropriate care for H. pylori. A pilot study was carried out in order to identify the current status of H. pylori knowledge, attitudes and practices of the local health care professionals in Léogane, Haiti. This research has identified potential diagnostic antigens for future use in H. pylori diagnosis and has identified some of the current gaps that should be addressed if an educational program is developed, so that the people are receiving the best possible care for H. pylori infections. This initial data can be used to aid in the development of larger studies and programs to help reduce the H. pylori prevalence in Haiti. These projects were the initial steps of what will hopefully develop into a larger program focused on developing capacities to reduce the prevalence of H. pylori in Haiti.

5 Name: Michael Dineen Degree and Year: Preprofessional Studies University of Notre Dame, 2012 The development and assessment of a new bio-chip based rapid diagnostic test for Human Filariasis in Haiti Diagnostic tools are essential for efficiently and cost-effectively diagnosing illness, selecting appropriate treatment, monitoring chronic diseases, and tracking the prevalence and impact of disease globally. Diagnostic tools that can be used in low resource areas are of essential importance. In countries like Haiti, that have low resources and limited access to lab based diagnostics, testing for disease in the field or at a point of care (POC) becomes paramount. One type of test that can be used is a rapid diagnostic test (RDT). These tests are designed to be used in a point of care situation, and can be used by minimally trained health workers, in order to provide a rapid diagnosis to the patient in the field. The current RDT that is endorsed by the WHO for the testing of Wuchereria bancrofti filariasis is the Immunochromatographic Card Test (ICT). The ICT card test is a sensitive test, but must be read in a time dependent manner according to the instructions. If that is not done then false positives or negatives may result. The development of a new RDT with both high sensitivity and specificity would improve the ability to reliably diagnose the infection which is a fundamental need to both the management of individual patients as well as the public health efforts to control the disease. The purpose of this study was to assess a new bio-chip based rapid diagnostic test for human filariasis in Haiti, and compare its sensitivity, specificity, and cost effectiveness to the World Health Organization's field standard ICT-card test. Through testing I developed a new bio-chip study model, NESDEP IU. Though it did not prove to be a faster testing model than the RDT ICT, I think the NESDEP IU could serve as a diagnostic tool in point-of-care settings, as well as tool for monitoring and surveying current MDA programs. I was able to spend a week with my father operating on 25 patients who had developed scrotal hydroceles, one of the debilitating and deforming disease manifestations of bancroftian lymphatic filariasis. We were unable to find any worms, but the trip and my experience was still a success, one that I enjoyed immensely.

6 Name: Cesar Padilla Degree and Year: Biology California State University- LA, 2012 Social determinants of intent to perform oral hygiene behavior in rural Dominican Republic The goal of the study was to identify the psychosocial determinants of oral hygiene behavior centered on the theory of planned behavior in rural Dominican Republic. The cross sectional study included 150 participants. Participants completed a voluntary, 54 question, culturally adapted survey which included both demographic and oral health questions. Correlation and regression analyses were used to determine variable associations and construct a model determining the intent to perform the minimum recommended oral hygiene behavior. The statistically significant model of intent to perform oral hygiene behavior accounted for 58.8% of the variance (p<0.005). Perceived behavioral control and attitude were identified as the statistically significant social determinants of the intention to perform minimum oral hygiene behavior (p<0.05). This study further stresses the need to identify the social determinants of oral health behavior in order to create evidence-based interventions. In the case of rural Dominican Republic, oral health interventions need to be targeted at changing individuals attitudes and perception of their care in regards to ideal oral hygiene behavior. In the case of rural Dominican Republic, oral health interventions need to be targeted at changing individuals attitudes and perceptions of their care in regards to ideal oral hygiene behavior.

7 Name: Shereen Shojaat Degree and Year: Kinesiology and Health Iowa State University, 2013 A health needs assessment at Basile Moreau School in Carrefour, Port-au-Prince, Haiti Environmental factors, food insecurities, poverty, political unrest, and natural disasters influence the health of Haitians, particularly children. A school setting as a health intervention site can be effective, due to high accessibility and enrollment rates of children in Haiti. To determine the health needs of the Basile Moreau School student population in Port-au-Prince Haiti, this study investigated the need for improving schoolbased health and health services for children attending the school through key informant interviews, observation, and a parent survey. Results suggest the need for addressing health-related issues at Basile Moreau School. Overall, our recommendation includes a coordinated school health approach consisting of eight core components, developed by the Centers for Disease Control, as an efficient and practical strategy for improving the health of students at Basile Moreau School. All component recommendations propose comprehensive program strategies, which extend beyond an onsite school healthcare facility. This approach may not only influence improved health outcomes for students at Basile Moreau, but has the potential to become a sustainable model for schools throughout Haiti. I will use all the knowledge and skills I gained through this work and apply it in my future career in global health, as well as life outside of my career.