Thomas C. Quinn and Steven Reynolds
Uganda
Bloomberg School of Public Health, MHS/MPH program >> View Final Report
HSV-2 infection is associated with increased HIV acquisition and transmission and has been shown to result in elevated levels of HIV-1 RNA in plasma and genital secretions. Recent clinical trials have demonstrated significant reductions in HIV-1 RNA plasma and genital viral loads with the HSV-suppressive therapy of acyclovir. A randomized, double-blinded, placebo-controlled study of 440 HIV/HSV co-infected individuals in Rakai, Uganda, will address the question of whether acyclovir monotherapy slows HIV disease progression, as measured by CD4+ cell decline or development of AIDS-defining illness. Individuals will be followed for 104 weeks for primary and secondary outcomes. A secondary objective of this study is to examine the effects of acyclovir upon subjective quality of life measures. Mental and physical well-being will be assessed through questionnaires administered monthly to the study enrollees and changes over time will be examined using longitudinal data analysis. We hypothesize that, after controlling for residual confounding, HSV suppressive therapy will be associated with improved measures of quality of life and that the strength of the effect will increase with treatment duration. Evidence for slowed HIV disease progression and improved quality of life measures with suppressive treatment of HSV disease bears important implications in the global battle against HIV disease and transmission.
Personal Statement:
I had an unforgettable ten weeks in Uganda. The first seven weeks were spent primarily in the rural town of Kalisizo, Uganda, the home of the Rakai Health Sciences Program. During these months, I gained unparalleled clinical and research experience.
As a future physician, I enjoyed and was very interested in the HIV clinical care in Uganda. I was invited to join the antiretroviral treatment teams on their clinic days, which were held in very remote towns throughout the Rakai district. Though limited by the language barrier, I saw a number of clinical cases of infectious pathology I had never seen in the U.S., and I participated in clinical decision-making. Seeing the patients and the reality of practicing medicine in a limited-resource setting was an opportunity that allowed me to truly understand the practice of global medicine while also prompting questions and inquiries I had never considered or explored during medical school in Baltimore.
From a research perspective, like the clinical experience, I was able to participate and witness the challenges and tools necessary to carry out a large randomized, controlled study in an international setting. I was able to actually sit in on interviews and informed consents of study participants, offering an understanding of the data I subsequently analyzed that I could not have gained otherwise.
Finally, from a personal perspective, my time in Africa was an experience that will forever shape my future plans and perspectives. This was my first experience living abroad, and rural Africa was definitely foreign. However, the hospitality and friendliness of the Ugandan people I worked with and lived with were the perfect balance for the culture shock I experienced immediately upon my arrival.
I will always treasure memories of the sights, smells, and sounds of Africa, and I look forward to continuing my work as a physician, researcher, and public health advocate in an international arena. As I told my colleagues in Uganda, I hope one day to return.
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