DGHI Awards Pilot Grants to Support Zika and Family Planning Projects

April 05, 2016

The Duke Global Health Institute (DGHI) has awarded grants for two research projects focused on maternal, adolescent and child health—one of DGHI’s research priorities. One award was given to Sallie Permar, associate professor of pediatrics, immunology, and molecular genetics and microbiology, and the other to Eric Green, assistant professor of global health.

Defining Maternal Antibody Responses against Zika 

Identification of the Zika virus in amniotic fluid, placenta and fetuses of affected pregnancies has linked Zika to the startling rise in microcephaly in Brazil, from approximately 150 cases per year to more than 4,000 cases within only a few months. 

Vector control can be used to help keep the Zika epidemic at bay, but only a maternal vaccine will protect all infants against permanent brain damage and birth defects associated with Zika. However, the scientific community’s understanding of the natural immune responses to Zika infection and their impact on virus transmission and disease—knowledge that’s critical for vaccine development—is at its earliest stages. 

With $25,000 in pilot funding from DGHI, Sallie Permar, a DGHI affiliate faculty member, is hoping to advance our understanding of the virus. Building on her extensive work on perinatal virus infections and HIV vaccine development, Permar hopes to define natural maternal antibody responses against Zika and how they relate to fetal outcomes.

Permar and her team will investigate how immune responses develop to natural Zika infection and which responses may be critical to impeding placental transmission and fetal disease. Understanding the placental transmission rate, extent of fetal disease and whether natural immunity provides some protection, she says, is essential to defining the end points for clinical vaccine development.

This grant will pair experts in global health and perinatal vaccine immunology with clinical and diagnostic experts working at the epicenter of the Zika epidemic. Permar’s co-investigators include Ralph Corey, professor of medicine, global health and pathology at Duke, and Reynaldo Dietze, professor and director of Núcleo de Doenças Infecciosas (Center for Infectious Diseases) at Universidade Federal do Espirito Santo in Victoria, Brazil. 

Permar says this funding came at a key juncture in this emerging epidemic. “It will provide key resources for patient diagnosis, sample collection and immune assays that are the first steps toward building the knowledge needed to inform a successful vaccine,” she said. “And it also helps solidify our collaboration with our Brazilian colleague.” 

Can social venture mPango increase contraception use in Kenya?

The United Nations projected that in 2015, 8,000 Kenyan women would die during pregnancy or in the first 42 days after childbirth. Unmet family planning needs contribute to this devastating toll. Nearly two million Kenyan women are not using contraception but say they would like to, and millions of others are either unaware of the potential benefits, misinformed about modern methods or unsatisfied with previous contraception experiences. 

Eric Green, an assistant professor of global health who has worked extensively in Kenya, hopes mPango, a new digital marketplace for family planning, will help minimize these challenges and increase contraception use among Kenyan women. mPango—“pango” means “plan” in Kiswahili—will educate callers about family planning, offer free automated counseling, recommend contraceptive methods and make referrals to local providers. Green is developing mPango with Ben Bellows, associate at the Population Council, and Siddhartha Goyal, chief technology officer of TinyURL and technology startup veteran. They built the core platform with seed funding from Merck for Mothers, a 10-year maternal health initiative from Merck.

With Green’s recent $13,900 grant from DGHI, the team will conduct a pilot study this summer in Bungoma County, Kenya, using a randomized encouragement design to estimate the impact of mPango on the uptake of contraception among women with an unmet need for family planning.

In a randomized encouragement design, participants are randomized to receive an invitation or special encouragement to receive a treatment. If those randomly selected to receive the encouragement (treatment group) use the service at a higher rate than those who receive only an invitation (control group), the impact of the service can be estimated.

Green anticipates that the study will result in sufficient data needed to seek further funding to scale the program nationwide and conduct additional implementation science research on how to promote the uptake of family planning. He and his team have high hopes for mPango; they believe it will address unmet needs for contraception, incentivize health providers to diversify the family planning methods they offer and expand the family planning market.

“This is a great opportunity from DGHI to examine the impact of mPango," Green said. The results will complement our work on user-centered design and hopefully set us up for success.”

In addition to Green, Bellows and Goyal, the mPango team includes three individuals based in Uganda and Kenya and seven Duke graduate and undergraduate students, including first-year Master of Science in Global Health student Alex Whitcomb and global health major Christina Schmidt, who will both play an active role in this pilot study.

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mPango team member Daphine recording audio prompts for the mHealth platform mPango. Principal investigator Eric Green recently received pilot funding from DGHI to advance this project.

[This pilot grant] will provide key resources for patient diagnosis, sample collection and immune assays that are the first steps toward building the knowledge needed to inform a successful vaccine.

Sallie Permar, associate professor of pediatrics, immunology, and molecular genetics and microbiology

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