Pamela Murnane, PhD, an assistant professor in the Institute for Global Health Sciences and the Department of Epidemiology and Biostatistics, was named one of this year’s Dean’s Population Health and Health Equity Scholars. The award recognizes her work on preventing transmission of HIV from mom to baby in resource-constrained settings, specifically Kenya. Without medication, somewhere between 15-45% of mothers living with HIV transmit the virus to their infants during pregnancy, birth or breastfeeding. With medication, this risk is virtually eliminated.
The award supports researchers whose work shows commitment to expanding health equity.
In HIV/AIDS work, equity mainly means ensuring that people in resource-constrained settings can benefit from antiretroviral therapy nearly as much as people do in high-income countries, where the drugs have defanged the virus.
“We have the tools. We have the treatment. We have prevention approaches that are effective,” Murnane said of mother-to-child transmission. “But delivering them to the right people at the right time in a way that meets their needs is really tough.”
In her K award work, Murnane attempted to develop a score based on commonly collected data that would identify pregnant HIV-positive women at highest risk of dropping out of medical care. But it turned out that these routine data points were not enough to predict which women would stop taking medication before their babies were weaned from breastmilk.
“We think what gets in the way is a combination of social and economic circumstances, such as food insecurity, depression and stigma – you have to go to the clinic to get the medications and somebody might see you,” Murnane said.
Interventions developed by FACES – a UCSF partnership with the Kenya Medical Research Institute, which launched as Family AIDS Care and Education Services – provided additional support for all women who faced additional barriers, including young age, recent HIV diagnosis and recent migration into the area. These patients attended clinic on a specific day when the entire medical staff and the patients’ assigned case managers were there to address any questions or challenges. The staff tried to meet each individual’s needs to help them remain on the medications.
These interventions seem to have kept more women in care and reduced the share of babies who became HIV positive.
Murnane’s project that the Population Health and Health Equity Scholars program is funding consists of a before-and-after comparison of these metrics to evaluate how effective the intervention was. Working with FACES director Francesca Odhiambo, MBChB, and UCSF's principal investigator for FACES, Craig Cohen, MD, Murnane will also try to pin down the impact any other factors may have had to paint a clear picture of what personalized care can achieve.
Addressing mother-to-child transmission may not be complicated, but it is hard. That’s the paradox that keeps Murnane engaged with the problem of perinatal HIV transmission.
“My first opportunity as an MPH student in epidemiology was to look at maternal health in the context of HIV before antiretroviral therapy was available. The field has changed so much since then – it’s so promising, and yet it’s so frustrating that it’s still so hard to do,” Murnane said. “My colleagues in Kenya work so hard and are so full of amazing ideas; that keeps me inspired.”
Spoken like a proven advocate for health equity.