The TESTsmART Team is used to meeting virtually, and had mastered the art of Zoom meetings before it became the modus operandi of the post-COVID world. Team members are physically based in the USA (from Durham, NC to San Francisco, CA), Kenya, Nigeria, and Uganda, but every Wednesday, the entire team logs onto Zoom to meet and discuss the study. Team members provide status updates, review monitoring and evaluation reports, and collaborate on solutions to operational challenges.
Right before the COVID-19 pandemic hit and life as the world knew it was severely interrupted, the TESTsmART study team snuck in one last in-person meeting to prepare for the launch of Aim 2 of our study.
After months of hard work and preparation for the study launch (which included developing the study protocol , designing the data collection tools, obtaining ethics approval from 3 different institutional review boards (IRBs), and conducting baseline surveys at potential retail outlets, writing standard operating procedures for every aspect of study implementation), the international team decided to officially kickoff Aim 2 by convening together in Eldoret, Kenya for a two day, in-person training.
The TESTsmART Team member who attended the team training in Eldoret
Day 1 kicked off with a study overview and review of the 12 study standard operating procedures (SOPs). Team members took turns presenting and were quizzed on their knowledge of the protocol and all the SOPs in a high stakes challenge between the Duke-Kenya and CHAI-Nigeria study teams. Up for grabs was bragging rights and the study mascot, affectionately known as the TESTsmART Teddy. At the end of the day, Kenya team prevailed!
Day 2 started early with the entire team traveling out to the field site in Webuye, about 2 hrs from the Eldoret office. The team met the Field Researchers at the home base at PEARL, and discussed the next stages of the launch focused on the retail outlets including enrollment, training, and arm randomization. The teams split up into smaller groups to go out and gain firsthand experiences at retail outlets in the area. In the afternoon, the team members reconvened to debrief about their observations from the day and chart timelines and next steps for rolling out the study intervention.
Everyone left feeling energized and excited for the launch of the project that they had been working so hard to prepare for.
Meet Christine Markwalter! She is one of the postdocs working with the O’Meara Lab and has been a member of the greater malaria research community at Duke for 3 years. Christine came to Duke after completing her doctoral studies at Vanderbilt University in chemistry. She is currently focused on a project analyzing haplotypes from mosquitos and humans that are a part of the Once Bitten cohort study, as well as some haplotype data from our Turkana project.
So how did Christine end up studying malaria in Kenya with a PhD in chemistry, you might ask?
Well, by way of bioanalytical chemistry, actually. For her doctoral work, Christine was investigating how to make rapid diagnostic tests (RDTs) more sensitive in order to detect lower density infections, specifically for malaria and schistosomiasis. After she finished her PhD studies in the lab, she decided she wanted to gain more epidemiology and field work experience, which is what ultimately landed her in the Malaria Collaboratory at Duke.
This past summer, Christine was able to spend 3 weeks in Kenya. This was her first trip visiting the field site there, and her trip started off with the ever-eventful loss of luggage by the airline. Normally this wouldn’t have been a huge deal for a seasoned traveler like Christine, but this time she was traveling with her husband Daniel, an Emergency Medicine fellow at UNC, and their baby daughter Ellis. Thankfully they had packed most of baby Ellis’ items in their carry-on’s, but the first day or two in Eldoret were spent going back and forth to the local mall to get spare clothes and supplies.
The ExactDx team, in true harambee fashion, did their best to help Christine and her family settle in sans luggage. On the way from the airport to retrieve their suitcases a few days later, Edna and Julius thought it would be fun to give Christine and Daniel a taste of traditional Kenyan cuisine. They stopped off and treated them to some nyama choma (grilled goat meat) and ugali. The meal remains a favorite from their visit, and Christine and Daniel cannot wait for their next opportunity to enjoy delicious Kenyan cuisine.
After a week of orientation in Eldoret, meeting with different team members in person, including some collaborators at Moi University, Christine and baby Ellis headed out to Webuye to experience a day of “ento.” “Ento” is short for “entomology” and refers to the days when field researchers (FRs) strap on their prokopacks and visit each of the households enrolled in the Once Bitten study to collect mosquitoes. The days begin early, usually around 6 am. This is the optimal time for catching mosquitoes in the households where they have potentially bitten members during the night. Household members are asked to keep windows and doors closed until team members arrive for mosquito collection.
“I was blown away with how generous the study participants are, letting the study team into their homes to collect the mosquitoes so early in the mornings. To me that is typical of the Kenyan hospitality I experienced throughout my trip,” recalled Christine.
Christine enjoyed getting to use the prokopack and helping collect some of the mosquitoes whose bloodmeals she’ll ultimately end up analyzing in the US. She was able to spend the afternoon with the FRs back at PEARL where she observed them sort species, rear, sacrifice and dissect the mosquitoes. The team places the mosquito parts (head, wing, and abdomen) in pre-labeled eppendorf tubes and package them by household and village before shipping them to the Taylor lab in the US. Once in Durham, members of the Taylor lab receive the mosquito parts (heads, wings, and abdomens) and processes the mosquitoes further, extracting and sequencing parasite DNA for analyses. This field visit provided Christine with knowledge and insight about the context and environment from which samples are collected, and will give her a richer understanding as she conducts her analyses and thinks about the team’s scientific questions.
In addition to gaining invaluable field experience, Christine volunteered some of her laboratory expertise at PEARL to help get a mosquito PCR speciation assay up and running. One difference she noticed between the lab set up in rural Webuye compared to Durham was the impressive amount of planning and forethought required to keep things running smoothly in the lab. At Duke, if a reagent runs out or if she runs into a problem with an instrument, she can just make an online order for next day delivery or take advantage of the many resources and experts available on campus. When challenges arise in the lab in Webuye, the team approaches them with creativity and careful planning, keeping a detailed inventory log so that orders can be placed months in advance. Christine was impressed by the molecular assays and techniques the PEARL team performs, and she is excited by the lab’s potential to do more as the program continues to grow there.
Christine leads a CME course via Zoom.
Christine also facilitated the monthly CME course for July, which is part of the many training activities that are conducted out of PEARL. Her topic was diagnostic technologies and she went over the advantages/disadvantages of different formats (rapid tests, PCR, antibody detection, etc.). The topic was very timely given the recent discussion globally around COVID-19 diagnostic methods and was attended by clinicians and researchers at PEARL and virtually.
She wrapped up her trip in Eldoret working with some other expat collaborators who were fortuitously visiting our office at the same time (a rarity during pandemic times!). She and her family are so grateful to have met the ExactDx team in person and for their genuine hospitality and care. They are already looking forward to returning! Karibu!
Wendy OMeara and Eric Nalianya demonstrate for Governor Wangamati and Dean Atwoli the telemedicine capacity being developed at PEARL
On Thursday, the Governor of Bungoma County, the Vice Chancellor of Moi University, the Dean of Medicine and Dean of Public Health of Moi University joined Dr. O’Meara, Dr.
Laktabai and Dr. Kisaka to official open the PEARL laboratory in Webuye, Kenya.
PEARL is the latest development in a longstanding partnership between Moi University in Eldoret, Kenya, Webuye County Hospital and Duke University. The lab is being established under the leadership of Jeremiah Laktabai, chair of the Department of Family Medicine at Moi University, and Wendy Prudhomme-O’Meara, an associate professor of medicine and global health at Duke University who’s based full-time in Eldoret.
Housed in two forty-foot refurbished shipping containers with a state-of-the-art multi-head teaching microscope, the lab will initially focus on building clinical microscopy skills among technicians across 224 facilities in the region. Microscopes are a cost-effective and versatile tool for examining patient specimens and making accurate diagnoses, and nearly every rural health center in Kenya has a microscope. However, with the exception of malaria smears, these diagnostic tests are rarely performed due primarily to lack of expertise.
“There are so many different ways you can improve patient care with a microscope if you have the training to use it,” said Prudhomme-O’Meara. “We’re developing programs to help technicians in rural facilities learn how to better support clinical care with their microscope, which in many cases is the only piece of diagnostic equipment they have.”
Another goal of the lab is to support ongoing research efforts in Bungoma County, including studies on and interventions for HIV, hypertension, diabetes, fevers in children and malaria transmission, led by local and international faculty and trainees.
“Through our collaborative research projects, we’ve been able to improve care and prevention for illness in Bungoma County and beyond,” said Prudhomme-O’Meara. “We expect that PEARL will help us expand this work and impact, as access to a research laboratory will allow Moi University faculty and their partners to tackle critical research questions affecting clinical care and community health.”
Here’s a link to a story in the Kenyan national news:
The lab building and infrastructure were made possible by support from Webuye County Hospital, Duke University and The Bill & Melinda Gates Foundation.
