Peru

Mr. Abdeen will spend his fellowship year at Universidad Peruana Cayetano Heredia in Lima, Peru under the mentorship of Patricia Garcia, MD, MPH, PhD, and Evelyn Hsieh, MD, PhD. His research will focus on risk factors and prevalence of hand osteoarthritis among patients with HIV. Mr. Abdeen is a third-year medical student at the Penn State College of Medicine. He aspires to become a holistic and culturally adept orthopedic surgeon that has the means to affect people in a multitude of ways. His faith, Islam, has been the main source of influence throughout his life. His career trajectory has been influenced by Drs. Fadia Kamal, John Elfar, and David Glazier.

Dr. Malca Hernandez spent his fellowship year at Universidad Peruana Cayetano Heredia (UPCH) in Lima under the mentorship of Patricia Garcia, PhD, MPH, MD and Evelyn Hsieh, PhD, MPH, MD. His research focused on exploring the interrelationships of aging expectations and quality of life, depression, stigma, and musculoskeletal health among middle-aged and older patients with HTV in Peru. Dr. Malca Hernandez received his medical degree from UPCH. He is a budding researcher whose career goal is to contribute to developing public health policies to reduce the impact of infectious and tropical diseases in Peru, South America, and globally. Also, he is interested in pursuing a Master of Global Health and maintaining the relationships formed at the NTH orientation and Yale in order to plan for future research collaborations.

Fellowship Site: Universidad Peruana Cayetano HerediaUS Institution: Yale UniversityProject Title: Prevention of Osteoporosis-Related Fractures Among HIV Positive Women in Peru: Assessment of Risk Scores, Knowledge and Health BeliefsAround the world, osteoporosis-related fractures cause significant morbidity and mortality. Patients with HIV are at increased risk for osteoporosis and fractures due to a combination of traditional risk factors, the nature of chronic infection, and antiretroviral therapy. Dual-energy x-ray absorptiometry (DXA) is the gold-standard technique to assess bone mineral density (BMD), the measure by which osteoporosis is diagnosed. Because it is often not economically or logistically practical to obtain DXA scans for all individuals of a certain age or gender, osteoporosis risk scores have been developed to assist clinical judgement and identify patients at highest risk so they can be referred for DXA screening. In countries like Peru, where DXA machines are not widely available, this targeted approach is particularly important.In the general population, several osteoporosis risk scores have been validated, however, none of these tools have been studied in HIV positive women in Latin America, and no literature exists on how they can be incorporated into osteoporosis prevention strategies for this population. To optimize the uptake of prevention strategies among women with HIV, understanding patient-oriented factors such as knowledge and health beliefs regarding osteoporosis is critically important. Approximately 1250 women receive care at the HIV clinic at Loayza Hospital in Lima, Peru. Our proposal will work with a cohort of HIV-positive women over the age of 50 years with previously collected BMD results to measure the performance characteristics (sensitivity, specificity, area under the receiver operating characteristic curve) of four validated osteoporosis risk scores (Osteorisk, SCORE, ORAI, OST). Patients returning for routine follow up to the HIV clinic will complete the osteoporosis knowledge test and osteoporosis health beliefs score. These surveys are theory-driven, validated tools for assessment of osteoporosis-related knowledge and health beliefs that have been used successfully among community-dwelling Peruvian women. The ultimate goal of our project is to provide valuable insight into how screening and prevention of osteoporosis may be optimized, within the resource practicalities of countries like Peru, for an HIV positive population.

Dr. Sanchez Rodriguez will spend her fellowship year at Universidad Peruana Cayetano Heredia Hospital in Lima, Peru under the mentorship of Patricia Garcia, MD, MPH, PhD, Evelyn Hsieh, MD, PhD, and Eleanor Reid MD, MSc, PhD. Her research will focus on assessing the needs and barriers to palliative care services in emergency department settings in Lima, Perú. Dr. Sanchez Rodriguez is an Emergency Medicine Physician at Yale University. She aspires to evaluate and implement strategies to improve palliative and end of life care in Emergency Medicine units in Latin America. Her largest influence stems from her experience as an Emergency Medicine Resident in her home, Puerto Rico. Limited resources and organization often hindered physician ability to provide comprehensive and sensible care to patients nearing their end of life.

Ms. Woodson spent her fellowship year at Universidad Peruana Cayetano Heredia (UPCH) in Lima under the mentorship of Magaly Blas, PhD, MD and Purnima Madhivanan, MBBS, MPH, PhD. Her research focused on exploring the sexual and reproductive health of adolescent women in vulnerable populations in the Amazon Basin. Ms. Woodson is a candidate in Epidemiology at the University of Arizona. She is currently a Fulbright Fogarty scholar in Peru working with the Universidad Peruana Cayetano Heredia (UPCH) and the organization, Mamas del Rio. Ms. Woodson hopes to use this knowledge to help inform programs within the Amazon Basin region to help reduce adolescent pregnancy and to promote greater gender equality around reproductive health issues.