Published August 11, 2008, last updated on March 8, 2013 under Research News
Q: You majored in economics at Yale. How did you end up in epidemiology?
Pence:
After college I realized that economics didn’t really speak to me. I taught math for two years, but was interested in foreign policy. I fell into an entry-level job filling publication orders for the Population Council in New York, which focuses on maternal and reproductive health. I had never considered public health as a career – it wasn’t even on my radar screen in college. But while I was working at this job I realized public health was a field that brought together my love of math with my love of writing and my larger goal of doing something for the world. It was serendipity.
Q: Your current research focuses on understanding how mental health and substance abuse influence the ability of people living with HIV/AIDS to cope with their illness. How did you get interested in HIV/AIDS?
Pence:
When I went back to school for my MPH and PhD, it became clear to me that HIV is a disease of the disenfranchised. It is sweeping the globe, but following the fault lines of poverty and disempowerment. Particularly in the U.S., it is increasingly concentrated in populations who are poor, who lack health insurance, and who have historically poor results from government and health care in general. I saw that there was an ongoing need for ways to develop a comprehensive response to HIV that would cut across disciplinary lines.
Then I was inspired by a lecture by Glenn Treisman from Johns Hopkins. He talked about a silent epidemic within HIV – the unrecognized, undiagnosed, and untreated epidemic of mental health issues. It spoke to me as a compelling need and I could see how mental health issues tie into so many other critical aspects of HIV/AIDS treatment and prevention; issues such as medication adherence and risk behaviors.
After that, it was a matter of falling in with inspiring faculty members at Duke such as Kate Whetten and others at the Center for Health Policy who were working on related issues.
Q: What are your current research projects?
Pence:
I am excited to be involved with CHAT [Coping with HIV/AIDS in Tanzania], which recently received funding from the NIH. We know that HIV/AIDS patients often have mental health issues. As antiretroviral medicines become increasingly available in Tanzania and other sub-Saharan countries, we need to have a good understanding of the determinants of medication adherence and risk behaviors among this population. We know that those who take medicines sporadically often develop resistance and have bad health outcomes. We want to prevent that.
A second project for which we are seeking funding from NIH is a pilot program in Cameroon that will focus on training mid-level providers, such as nurse practitioners, to identify and treat depression in people with AIDS. We believe that we can train these providers, under appropriate oversight from a psychiatrist, to measure patients’ symptoms of depression and side effects of medication every two weeks and follow algorithms to determine the best antidepressant dosages and to monitor response and side effects. We ultimately hope to understand whether effective depression treatment reduces risk behaviors and improves medication adherence and HIV clinical outcomes in this population.
