“Congratulations to the UM researchers who secured CIHR funding for their cutting-edge work in health and well-being,” said Dr. Mario Pinto, UM vice-president, research and international. “This recognition highlights the impact of UM’s innovative health research. These researchers are driving solutions for better health care in Manitoba and globally.” 

Dr. Peter Nickerson, vice-provost (health sciences) and dean of the Rady Faculty of Health Sciences, said the funded projects show the diversity of health research taking place across UM ranging from investigating gut health and HIV/HPV progression to reducing inequities in trail use for urban First Nation and Métis people and examining the interaction of dietary flaxseed with blood pressure medication. 

“The researchers who received project funding are from eight different Max Rady College of Medicine departments, the College of Pharmacy, the Faculty of Education and the Faculty of Agricultural and Food Sciences,” Nickerson said. “CIHR funding is vital to the research that takes place at UM. And it’s essential in advancing science with provincial, national and global implications.”  

One of the 12 grant recipients is Dr. Inna Rabinovich-Nikitin, assistant professor of physiology and pathophysiology at the Max Rady College of Medicine. She and her team received $1,032,750 over five years to study what could one day lead to new treatments to reduce the risk of heart disease in people with disrupted circadian rhythms.  

Circadian rhythms are 24-hour cycles that regulate changes in the body, including heart rate and blood pressure. When the circadian rhythm is disrupted by things like shift work, poor sleep or jet lag, it has a negative impact on the heart and could lead to heart disease, Rabinovich-Nikitin said.  

“It’s known that shift workers have a 40 per cent higher risk of heart attacks, but we can’t do without shift work, so our research is working to develop treatments to help people with disrupted circadian rhythm, such as shift workers,” said Rabinovich-Nikitin, who is also a researcher with the Institute of Cardiovascular Sciences, a joint St. Boniface Hospital Research and UM institute.  

Rabinovich-Nikitin’s preliminary studies suggest that a disrupted circadian rhythm results in abnormal lipid metabolism and accumulation of lipids in the heart, and this might be the underlying cause of heart failure following a heart attack.  

“The goal of the newly funded project is to determine how circadian genes affect lipid metabolism following a heart attack and to understand how modulation of circadian proteins can improve lipid metabolism and cardiac function following a heart attack,” she said.   

“We know how diet and exercise contribute to one’s health, but circadian rhythm is a neglected area of research. It’s very important to have a normal circadian rhythm, and we’re working hard to better understand its impact on our health.”     

UM CIHR project funding recipients 

Dr. Michel Aliani, professor of food and human nutritional sciences, Faculty of Agricultural and Food Sciences; principal investigator, nutritional metabolomics research, division of neurodegenerative disorders, St. Boniface Hospital Albrechtsen Research Centre 

Project: The capacity for dietary flaxseed to inhibit the metabolism of antihypertensive drugs 

Grant: $1,189,575 (five years) 

Using state-of-the-art instrumentation, Aliani’s study aims to prove that flaxseed ingested in the diet can interact with drugs that control blood pressure. Data from the study will explain the action of dietary flaxseed in lowering blood pressure and provide important safety data on the interaction of flaxseed in one’s diet with drugs that lower blood pressure.  

Dr. Marissa Becker, professor of community health sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences; director of technical collaborations at the Institute for Global Public Health 

Project: Prioritizing Place in Sexually Transmitted and Blood-Borne Infection prevention in Kenya: Reframing prevention programs through Program Science 

Grant: $975,375 (five years) 

Using a program science approach, Becker and the team will develop a deeper understanding of how physical, organizational, social and relational dimensions of “place” shape ecologies of risk and safety for prioritized adolescent girls and young women (15-24 years), female sex workers and their male sexual partners in Nairobi County, Kenya. This work will generate contextualized knowledge for prioritizing place-based strategies to optimize sexually transmitted and blood-borne infection prevention program coverage and address unmet needs.  

Dr. Lucy Delgado, assistant professor of educational administration, foundations and psychology, Faculty of Education 

Project: The impact of Métis-specific spaces on the health and wellness of Métis women and Two-Spirit/Indigiqueer people 

Grant: $1,017,452 (four years)  

Through data collected as part of a series of gatherings, interviews and qualitative surveys, Delgado’s project will measure the outcomes for Métis women and Two-Spirit/Indigiqueer peoples engaged in Métis-specific spaces and provide a framework for post-secondary institutions in their creation of Métis-specific spaces. The final stage of this project will be an evaluation of the efficacy of the framework when taken up by new institutions. 

Dr. Jason Kindrachuk, associate professor of medical microbiology and infectious diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences; Canada Research Chair in molecular pathogenesis of emerging viruses; researcher, Children’s Hospital Research Institute of Manitoba 

Project: Characterization of long-term sequelae and immune signatures in Ebola virus disease survivors from 1976-2014 in the Democratic Republic of the Congo 

Grant: $100,000 (one year) 

Kindrachuk’s study will determine whether long-term health impacts following Ebola virus disease are conserved across geographic locations and what epidemiologic or biological factors might be linked to more severe complications and immune durability. The team will focus on disease survivors from multiple historic Ebola virus disease outbreaks within the Democratic Republic of the Congo and will also examine this through questionnaires and analysis of historical samples.  

Dr. Jonathan McGavock, professor of pediatrics and child health, Max Rady College of Medicine, Rady Faculty of Health Sciences; researcher, Children’s Hospital Research Institute of Manitoba 

Project: Honoring Ourselves and the Land – Reducing inequities in trail use for First Nations and Métis people in urban centres in Manitoba 

Grant: $1,266,075 (five years) 

With the help of Elders and Indigenous families, McGavock and his team will deliver and evaluate four main themed urban trail cultural events: 1) Full Moon ceremony walk/ride for girls, women and two-spirited people. 2) Land-based teachings with Elders/Knowledge Keepers. 3) Medicine teachings. The team will work with non-governmental organizations to plant gardens and/or traditional medicines in parks adjacent to the trails. 4) Youth-led teachings about local Indigenous cultures, languages and traditions. 

Dr. Donald Miller, professor of pharmacology and therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences; researcher, Kleysen Institute for Advanced Medicine, Health Sciences Centre 

Project: Improving therapeutic outcomes in medulloblastoma through optimizing brain delivery of agents targeting inhibitors of apoptosis proteins 

Grant: $592,876 (four years) 

Miller’s medulloblastoma research will use a method his laboratory has developed and tested to selectively and reversibly open the blood-brain barrier to increase brain and tumour levels of chemotherapeutics and the XIAP sensitizing drugs to allow both radiation and chemotherapeutic agents to kill the tumour cells in the brain more effectively. Using peptides that target cadherin, the team will temporarily loosen the connections between the brain capillary endothelial cells to allow increased delivery of drugs and sensitizing agents to the brain tumour.  

Dr. Thomas Murooka, associate professor of immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences 

Project: Role of mucosal neutrophils in driving HIV/HPV infection and disease progression 

Grant: $1,139,850 (five years) 

Murooka’s project will focus on specific bacteria linked to inflammatory disease in the lower female genital tract and identify the immune cells that further exacerbate this disease process. The team will use an animal disease model to better understand how this inflammatory process increases HIV and HPV infection, with the overall goal of defining why some individuals are more prone to sexually transmitted infections and to test drug candidates that can lower acquisition risk.  

Dr. Liam O’Neil, assistant professor of internal medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences 

Project: Cigarette smoking induced neutrophilic inflammation as a modifiable risk factor for Rheumatoid Arthritis in First Nations 

Grant: $100,000 (one year)  

O’Neil will investigate the way cigarette smoking interacts with the immune system, leading to rheumatoid arthritis. The team believes neutrophils, a common immune cell, are particularly prone to inflammation, leading to abnormal immune responses in people at high risk for rheumatoid arthritis development.  

Dr. Dake Qi, associate professor, College of Pharmacy, Rady Faculty of Health Sciences 

Project: TAAR1 in adipose tissue is a novel therapeutic target to combat atypical antipsychotics (AAPs)-induced metabolic dysfunction via downregulation of MIF 

Grant: $849,150 (five years) 

Qi’s project will investigate how trace amine-associated receptor (TAAR1) downregulates the release of macrophage migration inhibitory factor in fat cells and its impact on metabolic dysfunction induced by the classic atypical antipsychotics (AAP), olanzapine, by utilizing a combination of molecular and cellular biology techniques and physiological animal models. The team believes that TAAR1 agonists will improve the clinical psychiatric treatment with AAPs. 

Dr. Deanna Santer, assistant professor of immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences 

Project: Role of type III interferons in regulating mucosal immunity in a healthy gut versus ulcerative colitis 

Grant: $967,725 (five years)  

Santer will study fresh gut tissues and blood collected from people with or without ulcerative colitis during routine clinic visits. The team will use a combination of their novel human biopsy culture model, 3D “mini-guts” and immune cells to find out exactly how type III interferons (IFN-L) promote gut health but also how IFN-L could dampen the overreactive immune cells causing symptoms.  

Dr. Jarret Woodmass, assistant professor of surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences 

Project: Reverse total shoulder arthroplasty with and without subscapularis repair: Randomized controlled trial evaluating patient-reported and clinical outcomes 

Grant: $455,175 (five years)  

The aim of Woodmass’ study is to conduct a high-quality, randomized trial comparing outcomes of reverse total shoulder replacement (RTSA) with and without subscapularis repair. This ground-breaking study will provide evidence to support or negate the ongoing use of subscapularis repair in RTSA to optimize patient outcomes and manage scarce health-care resources. 

“I congratulate these successful Rady Faculty researchers and their partner networks whose work is contributing to the highest attainable standard of health as a fundamental right here in Manitoba and around the world,” said Dr. Mario Pinto, UM’s vice-president (research and international). 

“It is wonderful to see Manitoba leading the nation with the highest average and median grant values, a testament to the outstanding quality of research conducted at the University of Manitoba.”  

Dr. Peter Nickerson, vice-provost (health sciences) and dean of the Rady Faculty of Health Sciences, said that the funded projects in the Spring 2024 competition show the diversity of health research taking place across the faculty.  

“The researchers are examining a wide range of topics – from new drug combinations to treat blood cancer to determining how the communication between astrocytes and neurons occurs. This CIHR funding is crucial for advancing science and will inevitably have an impact on the health of patients both locally and globally,” Nickerson said.  

One of the 11 Rady Faculty grant recipients is Dr. Jude Uzonna, professor of immunology at the Max Rady College of Medicine and vice-dean (research) at the Rady Faculty of Health Sciences. He and his team received $1,005,976 over five years to study what could one day lead to new treatments for leishmaniasis.  

Leishmaniasis is an understudied parasitic disease spread by sand flies that can cause skin sores and even fatal damage to internal organs. The disease affects more than 12 million people worldwide, Uzonna said, and it’s starting to spread to non-endemic countries like Canada.  

“It’s coming,” he said. “It’s really coming because of global warming, increased immigration from endemic countries to Canada and soldiers coming back from peacekeeping duties. The numbers are growing, but if we can develop a vaccine for it, then it becomes a magic bullet used to prevent it.”  

The team has found that leishmaniasis triggers the production of a molecule called pentraxin 3 (PTX3) in infected people. PTX3 weakens a specific part of the immune system that normally helps fight the parasite, so Uzonna suggests that targeting PTX3 might be a good way to develop new treatments for the disease.  

This study aims to better understand the role of PTX3 in the disease. It will also look at whether the level of PTX3 can predict if someone will benefit from treatment or not, which is important because the current drugs used can be toxic.  

“If we can show that PTX3 is causing a problem, then we can develop a molecule that can target and block PTX3 production. We can combine the molecule with a drug to make treatment more efficient and better. That will have a significant impact,” Uzonna said.  

Rady Faculty of Health Sciences CIHR project funding recipients 

Dr. Marissa Becker, professor of community health sciences, Max Rady College of Medicine 

Grant: $100,000 (one year)  

Using a program science approach, Becker and the team will develop a deeper understanding of how physical, organizational, social and relational dimensions of place shape ecologies of risk and safety for adolescent girls and young women, female sex workers and their male sexual partners in Nairobi County, Kenya. This work will generate contextualized knowledge for prioritizing place-based strategies to optimize sexually transmitted and blood-borne infection prevention program coverage and address unmet needs. 

Dr. Sanjiv Dhingra, professor of physiology and pathophysiology, Max Rady College of Medicine; researcher, Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre 

Grant: $1,067,176 (five years)  

Dhingra will lead a study focused on understanding the reasons for rejecting transplanted donor-derived mesenchymal stem cells in the heart. This research will help to develop strategies to prevent rejection and improve the survival of implanted stem cells in the heart. 

Dr. Jody Haigh, professor of pharmacology and therapeutics, Max Rady College of Medicine; researcher, Research Institute in Oncology and hematology, CancerCare Manitoba 

Grant: $1,071,000 (five years) 

Haigh aims to identify new drug combinations to treat aggressive forms of blood cancer and to determine ways to avoid drug resistance to these treatments that can sometimes occur during cancer therapy. This project will be important in identifying and confirming new drug approaches that can be used in personalized medical care for childhood and adult blood cancer patients in Canada. 

Dr. Julie Lajoie, assistant professor of medical microbiology and infectious diseases, and Francis A. Plummer Professorship in Global Infectious Diseases, Max Rady College of Medicine 

Grant: $1,132,200 (five years)  

Lajoie and the team will follow female sex workers from Nairobi, Kenya, who are using an injectable contraception called depot medroxyprogesterone acetate (DMPA) for six months and determine the immune activation and inflammatory profile in the blood and at the female genital tract. They will also examine whether using DMPA impacts the capacity to respond to previously exposed viruses and affects the cells’ capacity to respond to the stress hormone cortisol. 

Dr. Aaron Marshall, department head and professor of immunology, Max Rady College of Medicine; researcher, Research Institute in Oncology and Hematology, CancerCare Manitoba 

Grant: $1,151,326 (five years) 

Marshall’s project deals primarily with B lymphocytes, the immune system cells responsible for producing antibodies. The research aims to define the cellular reprogramming signals that either switch on or switch off B lymphocytes and how these networks are altered in chronic autoimmune disease. 

Dr. James Nagy, professor of physiology and pathophysiology, Max Rady College of Medicine 

Grant: $898,876 (five years)  

Using experimental mouse models, Nagy and the team will determine how spinal neurons, called V0c neurons, contribute to force level control in the limbs. He expects the results will challenge current textbook knowledge on force generation during movement and reveal new concepts on how command signals to motoneurons are converted to desired levels of muscle activity. 

Dr. Zulma Rueda, associate professor of medical microbiology and infectious diseases, Max Rady College of Medicine; Canada Research Chair in Sexually Transmitted Infection – Resistance and Control 

Grant: $688,501 (four years)  

Rueda will lead a study that will generate a comprehensive and systematic understanding of the knowledge, attitudes and practices about HIV and other sexually transmitted and blood-borne infections (STBBI) among people living with HIV and people who face disproportionate risk of acquiring HIV/STBBI (people experiencing houselessness, people who inject drugs) and health and service providers in Manitoba. 

Dr. Tabrez Siddiqui, associate professor of physiology and pathophysiology, Max Rady College of Medicine; researcher, Kleysen Institute for Advanced Medicine, Health Sciences Centre; researcher, Children’s Hospital Research Institute of Manitoba 

Grant: $1,143,676 (five years)  

Neurexins are essential proteins that help nerve cells in the brain communicate with each other, and changes in the genes for these proteins can increase the risk of developing autism. Siddiqui’s research highlights the possibility of fixing certain brain communication issues by targeting specific proteins, offering hope for new treatments. 

Dr. Jillian Stobart, assistant professor, College of Pharmacy 

Grant: $944,776 (five years)  

Stobart’s project aims to determine how the communication between astrocytes and neurons occurs. This will be the first evidence that astrocytes can change brain circuits responsible for the sense of touch and is important because astrocyte-neuron communication changes in disease. Problems with astrocytes and their communication with neurons could be the missing link in these disorders. 

Dr. Geoffrey Tranmer, associate professor, College of Pharmacy  

Grant: $730,576 (five years)  

Tranmer and the team plan to create new and improved versions of the ALS drug edaravone and test the drug-like properties of these molecules in test tubes and ALS animal models. This will allow the team to determine and optimize the drug properties of the new ALS drug and will enable them to develop an optimized drug candidate ready for advanced clinical trials. 

Dr. Keith Fowke and Dr. Mario Pinto with patient cohort at Nairobi research clinic.

Today, UM research in Kenya includes two major inter-related Rady Faculty of Health Sciences programs led by Keith Fowke, Department Head of Medical Microbiology and Infectious Diseases and James Blanchard, Executive Director of the Institute for Global Public Health. Responding to a need for public health advocacy from UM research partners in Kenya, Global Public Health programs expanded to Kenya in 2008 as an extension of successful projects originally started in India.

“Our programs in Kenya are a unique example of how laboratory-based researchers interested in molecules and cells are collaborating with researchers studying issues of stigmatization and together they make meaningful impacts for marginalized people,” said Keith Fowke.

As researchers began working with marginalized patient cohorts, increased need for community-based supports emerged, informing new programs developed by UM researchers Dr. Souradet Shaw Canada Research Chair (CRC) in Program Sciences & Global Public Health, Dr. Marissa Becker, Dr. Lisa Lazarus, Dr. Lisa Avery, Dr. Joshua Kimani, Dr. Larry Gelmon, Dr. Lyle McKinnon, Dr. Julie Lajoie, Dr. Leigh McClarty, Dr. Jason Kindrachuk CRC in Molecular Pathogenesis of Emerging and Re-Emerging Viruses and Dr. Rob Lorway, CRC in Global Intervention Politics and Social Transformation,. 

“When I first came to Kenya in 2009 there was a group of young men who were starting to attend clinics established for female sex workers, many of whom identified as gay and bisexual, which is criminalized in Kenya,” said Rob Lorway. “Some were young students, and some were older or married, but what was important is that they had a high HIV prevalence. They came to us because we provided safe spaces from Kenya’s public healthcare system that can be, at times, quite judgmental.”

A legacy of evidence-based support & patient directed research

Four decades ago in the early 1980s, after eradicating an outbreak of the sexually transmitted infection Chancroid in Manitoba, Dr. Allan Ronald was recruited to lead a similar program with the Department of Medical Microbiology at the University of Nairobi, Kenya. Dr. Francis Plummer, then an infectious disease fellow on Ronald’s team studying with a group of sex-workers, would gain global renown for the discovery of a link between the spread of sexually transmitted diseases and the emerging HIV/AIDS epidemic.

Among the patient cohort exposed to HIV/AIDS, Plummer and his team identified a group of women with a natural immunity to HIV-1, the virus that leads to AIDS. Over the following 17 years UM researchers, including Fowke, studied the immune system of these women leading to new approaches to HIV prevention. The women participating in the study had contributed to saving and improving the lives of tens of millions of people living with HIV around the world but continued to live a criminalized lifestyle at the fringes of society.

Dr Elizabeth Ngugi, a local public health nurse working with Plummer in managing the patient cohort in the 1980s and ‘90s, recognized the adversity these women and others like them endured each day. Through advocacy, a new patient-directed research model was developed to foreground the needs and voices of patients as fully recognized research partners, rather than research subjects.

Keith Fowke, who was a graduate student at UM labs in Kenya at that time, recalls of Dr. Ngugi, “she was a very direct and clear-thinking woman. Beginning in 1984, Dr. Ngugi developed a peer educator model to train sex workers and support them as informed and educated leaders within the community. Dr. Ngugi’s influence has been global and has resulted in a deep 40-year relationship with this community which has now evolved into the Sex Worker Outreach Program (SWOP) which has been adopted as a best-practice model by the World Health Organization, UN AIDS and countless others.”

Dr. Julie Lajoie (second from left), Dr. Mario Pinto, Joyce Adhiambo (pictured in SWOP t-shirt) and Dr. Keith Fowke pictured here.

Now in 2024, UM infectious disease research in Nairobi encompasses 10 SWOP clinics providing HIV prevention and care services to more than 30,000 female sex workers, about 9000 men who have sex with men and close to 1500 transgender individuals. Supported by Joshua Kimani and Larry Gelman who follows in the legacy left by Dr. Ngugi, some patient partners are now respected community organizers like Joyce Odhiambo with SWOP Ambassadors, who presented to EU Parliament in Brussels in 2018.

Current clinical programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) deliver HIV care and prevention services. However, due to the criminal status of sex work and homosexuality in Kenya, the mere presence of HIV medications or even condoms could provoke harassment or police response.

Members of the patient cohort meet at a Nairobi health clinic.

“In Kenya 4% of the general population is infected with HIV, and in sex workers it’s about 28%,” said Fowke. “Despite these high risks, many women in our cohort choose not to take anti-HIV drugs to prevent infection because of the stigma resulting from their association with being used to treat HIV infection. We are working on providing new approaches to HIV prevention that would be acceptable to these women, including the anti-inflammatory drug, aspirin, which may prevent the immune cell HIV infects from entering the vaginal mucosal environment thereby preventing infection.”

Community empowerment through global public health research

Members of the male patient cohort meet with Dr. Keith Fowke and Dr. Mario Pinto.

“We’re talking about marginalized and stigmatized people, whose lives and livelihoods are criminalized,” said Lorway. “Within the first year of our program 12% of men who have sex with men who originally tested negative for HIV were testing positive. So, despite clinicians doing everything they could at the time – providing risk reduction counseling, supplying condoms and lubricant – HIV infection was growing among these men in our cohort.”

Tourism in Kenya has influenced hotspots where gay and bisexual men can congregate and celebrate themselves. By mapping these hotspots, the Global Public Health team have provided local clinicians and community organizations the ability to establish program catchments and generate their own accurate community health data to inform program coverage targets that guide the funding priorities of donors and the Government of Kenya. Furthermore, by providing training to community leaders so that they can cultivate their own research agenda, now community leaders are coming to Lorway and the team for support with their own investigations.

These expanding partnerships have paved the way for organizations like SWOP Ambassadors, who provides legal aid training and support to sex workers and engages with police to ensure that the right to access healthcare services is respected. The internationally-funded community based organization, HOYMAS (Health Options for Young Men on HIV, AIDS, and Sexually transmitted infections) has now established a clinic in Nairobi which guarantees non-discriminatory care and runs anti-stigma campaigns focused on sexual health and human rights advocacy.

“The shifting scope of Global Public Health research in Kenya is a strong sign of transformational success,” said Mario Pinto, Vice-President (Research and International). “The work of these dedicated researchers and clinicians to advance health as a human right has empowered these underserved communities, not just in self-advocacy, but as entrepreneurs and leaders in their field on the international stage. We know that when people of sexual minorities live free of harassment and stigmatization, they are more likely to access life-saving medical care and be their authentic selves.”

CFI-Funded laboratory provides much-needed sex worker outreach programs

Dr. Keith Fowke and Dr. Mario Pinto pictured with Dr. Julius Oyugi, Director of the University of Nairobi Institute for Tropical and Infectious Diseases

In Kenya, UM has partnered with the University of Nairobi to build a Canada Foundation for Innovation funded lab on their campus and has now developed 10 different SWOP clinics across the city as part of ongoing sex worker outreach programs. “When we first started this program, there wasn’t much medical research infrastructure in Kenya, now I’m supervising Kenyan PhD students doing cutting edge research projects without having to leave their country and we are able to hire all staff locally through with grants available to African institutions,” said Keith Fowke.

Decades of results in overcoming epidemics and securing international funding from partners including Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS has helped to foster good relationships with government. health officials have signaled a willingness to collaborate on efforts to prevent an emerging epidemic of anal cancer among men who have sex with other men resulting from the sexually transmitted infection HPV.

“We have begun addressing an epidemic of cervical cancer resulting from HPV among female sex workers, but a different approach is needed to provide care for men who have sex with men,” said Lorway. “Hate speech almost constantly enters the political theatre during times of economic disruption like the COVID-19 pandemic, so it’s often about quiet negotiations with health official — which can be frustrating because of the urgent need for care. Working with our local partners we’ve established new provisions for anal health care for men who have sex with men. Although working in such a prohibitive political climate can be challenging, these partnerships provide the room we need to discretely develop programs without provoking a negative public reaction.”

Research impacts at home in Manitoba

Joyce Adhiambo (left) and Victoria Were (right)

“There is a presumption that access to care and sex worker support programs are less advanced in the global south. However, in Canada, by criminalizing the clients, we push sex works even further underground,” said Lorway. “Criminalizing sex work makes it extremely difficult to deliver health services. In this case we have something to learn from our work in Kenya about how to provide services to those who are hardest to reach.”

Leading the way in sex work advocacy in Manitoba is the Sex Workers of Winnipeg Action Coalition (SWWAC)  who are partnering with UM infectious disease expert Julie Lajoie, to facilitate an ongoing information exchange between the sex worker communities in Nairobi and Winnipeg. Two community leaders came to Winnipeg in 2022 to discuss their role as grant co-applicants and to share strategies on getting organized in the face of criminalization and public stigma.

“In Canada, we have a parallel issue of Missing and Murdered Indigenous Women, and tragically, there are commonalities in the experiences of marginalized people on both sides of the ocean,” said Keith Fowke. “In Manitoba we’re at least a decade behind African programs in HIV prevention approaches. There are more new cases of HIV in Manitoba this year than in epidemic of the 1980s and ‘90s, and it’s mainly among women in indigenous communities.  We need to adapt global best-practices to prevent infections in Manitoba.”

The Winnipeg-based community resource center Sunshine House is leading the way in Manitoba by offering HIV and sexually transmitted disease testing services and have held a Science + Supper, often featuring presentations from UM Faculty members.

“Programs like those offered at Sunshine House, SWWAC and SWOP Ambassadors are foundational,” said Lorway. “Something we as researchers can always work toward is the de-monopolization of science, to put the power to make change into the hands of those who most urgently need it.”

Dr. James Blanchard.

With funding from the Bill & Melinda Gates Foundation, UM researchers are working in India to build partnerships and improve maternal and newborn health outcomes. Since 2014, the UM has championed this life-saving initiative through the Institute for Global Public Health (IGPH), with newly published results showing a significant reduction in neonatal mortality.

Led by Dr. James Blanchard, Canada Research Chair in Epidemiology and Global Public Health and Executive Director of the IGPH within the Rady Faculty of Health Sciences, this unique partnership between the IGPH and the Government of Uttar Pradesh (GoUP) continues to help decrease maternal and neonatal mortality rates in the region. This project would not be possible without the leadership of GoUP and their commitment to implementing policies and programs to improve health outcomes in the region.

“By working collaboratively with local governments and other academic and development partners, we are able to strengthen health systems and develop healthcare policies to help improve outcomes for mothers and children across the state,” said Blanchard.

Dr. Marissa Becker.

Dr. Marissa Becker is a professor in the department of community health sciences and the department of medical microbiology and infectious diseases within the Rady Faculty of Health Sciences. She is also director of technical collaboration for the IGPH.

“We are focused on improving public health programs in India and reaching those who are most vulnerable in our society,” said Becker. “We are there as partners to learn together and create better programs that will make an impact.”

The UM team began in 2014 by adopting the policy goals of the India government and responding to their needs to build capacity in their public healthcare system. The GoUP prioritized the reduction of neonatal mortality as a central goal, as more than 45 newborns out of every 1,000 were dying within their first month of life.

To achieve this goal, the UM team developed systems and digital infrastructure to improve the availability and functionality of existing healthcare services. The systems range from human resources planning to supply chain management, data management, training and mentorship and research and analysis. These improved systems have helped the government and front-line providers provide higher quality and more accessible patient care, especially for women living in rural or remote areas.

A hospital in Lucknow Premis where newborns receive life-saving care and medical interventions.

Family planning is also being prioritized in Uttar Pradesh, where the UM is supporting the government with research and technical collaboration to improve access to modern contraceptives, nutrition and child and maternal health outcomes.

A large staff team has been deployed to support the planning and implementation of these transformative initiatives. Over 1,100 healthcare staff is in place including doctors, specialists, nurses and administrators. The scale of this work is significant and complex, with specialists assigned at the state, district, and village level to ensure the consistent implementation of programs and strategies across all 30,000 health facilities in Uttar Pradesh.

Dr. Becker and Dr. Pinto pictured with healthcare facility staff.

Dr. Mario Pinto visits a community-level healthcare facility.

Transforming healthcare through data systems

A key outcome of the IGPH’s progress in India has been the development of digital support systems to collect and track valuable data across the healthcare system.

Established systems include the collection of data on the healthcare workforce to improve staffing management and identify gaps. A database has been developed to track equipment and essential drugs to ensure facilities are well-equipped to provide emergency care and reduce maternal and neonatal mortality, while data is also being collected from front-line staff to track the delivery of services across the system and ensure coverage across the entire state.

During the COVID-19 pandemic, data management at scale was taken to another level when the UM team was asked to track all COVID-19 tests across the healthcare system. This system was so successful that the government has now expanded it to collect data on twelve notifiable diseases, including malaria, Japanese encephalitis, and others. This system collects significant amounts of data to allow the government to track outbreaks in real time and develop timely responses to emerging public health threats.

Report signals significant reduction in neonatal mortality

A new report published by the Government of India in summer 2023, the Exemplars in Maternal and Newborn Health India study, has found transformative progress in reducing maternal and newborn mortality over the last two decades. The report highlights key strategies and programs have made life-saving medical care widely accessible to mothers and newborns.

Key findings on health outcomes in Uttar Pradesh over the past 15 years include:

• A decrease in home births from 80% to 11%
• The neonatal mortality rate has decreased by 40%. This reduction has resulted in approximately 99,000 deaths being averted annually.
• The percentage of women accessing healthcare services during pregnancy has risen to 98%, representing a 38% improvement.

“I congratulate the Institute for Global Public Health team for achieving this international recognition of their work in India to provide high-quality and accessible medical care at scale for mothers and newborns,” said Dr. Mario Pinto, Vice President (Research and International). “Through Drs Blanchard and Becker’s expertise and leadership, the region has taken bold steps to establish a highly efficient and integrated care system that saves lives and is there for everyone.”

The medical oncologist and clinical researcher recently spearheaded an Early Palliative Care initiative at CancerCare that gives support to patients with incurable pancreatic cancer and their families soon after diagnosis, improving their quality of life.

Kim, who earned her medical degree at UM in 2007 and joined the faculty in 2014, also co-leads the multidisciplinary Hereditary Gastrointestinal Cancer Clinic at CancerCare. Unique in Canada, it brings together several types of specialists to help patients with Lynch syndrome, who are at high risk for cancer.

Although Kim has such successes under her belt, when she heard about the leadership development awards available to women in the Rady Faculty of Health Sciences through The Winnipeg Foundation’s Martha Donovan Fund, she saw an opportunity to enhance her skills as she enters her mid-career.

“There are challenges in health-care leadership that are unique to women,” Kim said. “I want to grow as a confident and capable leader, and as a mentor to other women.”   

Kim is one of six faculty members or students in the Rady Faculty who have just been announced as recipients of the 2022 Winnipeg Foundation Martha Donovan Women’s Leadership Development Awards.

Kim’s award funded her to attend a three-day online course, Career Advancement and Leadership Skills for Women in Healthcare, offered by the Harvard Medical School. She found it especially valuable to learn about communicating her ideas effectively, she said.

“As physicians, we don’t necessarily get training in how to promote our work, how to develop a program, or how to pitch an idea and explain why it’s valuable,” she said. “The course also addressed topics such as how to consider budgetary concerns and infrastructure needs while supporting innovative patient care.”

The $250,000 Winnipeg Foundation Martha Donovan Fund was established in 2019. Up to $50,000 is being awarded annually for five years.

“The feedback from previous years’ awardees who have completed their leadership programs confirms that they are immediately applying their new knowledge and skills,” said Dr. Sara Israels, vice-dean academic of the Rady Faculty.  

“My hope is that the women we support now will become mentors and sponsors to those coming behind them, so we really start to move the needle on diversity in our leadership teams.”

Here are the other 2022 award recipients:

Dr. Marissa Becker, associate professor at the Institute for Global Public Health (IGPH) in the department of community health sciences, will attend the 2023 Women in Medicine Summit in Chicago. The conference will focus on skills development, advocacy and action plans for leadership, the professor said.

Becker will also take part in an online workshop on women’s leadership for social impact in global health and development.

“This conference and workshop will provide complementary skill development for my leadership roles in academic medicine and global health,” Becker said.

Margaret Hart, Ininiw (Cree) scholar at the College of Rehabilitation Sciences and PhD candidate in the Faculty of Education, will attend the Women of Color Leadership Program at the Harvard Business School in Boston.

Hart, a First Nation woman with extensive experience as an Indigenous educator, is developing an Indigenous curriculum framework for the UM occupational therapy program.  

“Working towards transformational change in curriculum is a step forward in the Truth and Reconciliation Calls to Action,” said Hart. “The Harvard training will emphasize practical steps to enhance my leadership ability and fulfil my ambitions for curriculum transformation in academia.”

Kate Bernier, a master’s student in physiology and pathophysiology at the Max Rady College of Medicine, conducts research focused on a particular protein. She will take two leadership courses through the James W. Burns Executive Education Centre in the Asper School of Business at UM.

“I hope to apply what I learn in these courses towards my goal of building a career at the interface of science and medicine,” she said.

Sanjana Chauhan, a PhD student in pharmacology and therapeutics at the Max Rady College of Medicine, will attend the online Leadership in the 21st Century course offered by the Wharton School at the University of Pennsylvania.

“I am constantly motivated to improve my leadership skills by looking for new challenges and approaches,” said Chauhan, whose field is neuropharmacology. “This course will broaden my confidence and ability to speak in public.”

Kayla Kostal, a master’s student in community health sciences at the Max Rady College of Medicine, will attend the online Excellence in Healthcare Leadership Program offered by the Johnson Shoyama Graduate School of Public Policy in Saskatchewan.

Kostal, whose research areas include intellectual and developmental disabilities, said her overall goal is to make positive change in the community.

“I anticipate that this training program will help me learn, refine, improve and adapt my leadership skills to help meet this goal,” she said.

Awards through The Winnipeg Foundation’s Martha Donovan Fund are open to any woman who is a full- or part-time academic faculty member with a primary appointment in a college of the Rady Faculty, or a student, postdoctoral trainee or resident in the Rady Faculty. More information is available here.

Today, with a new transformational investment of $87 million USD over five years from the Bill & Melinda Gates Foundation, the partnership between the UM Institute for Global Public Health and the Government of Uttar Pradesh (GoUP) through the Uttar Pradesh Technical Support Unit (UP TSU) can continue to help GoUP drive down maternal and neonatal mortality rates in the region. This is achieved by working with local governments and other academic and development partners to strengthen health systems, to develop healthcare mentors and policies. All of which will continue to improve Reproductive, Maternal, Newborn, Child Health and Nutrition (RMCHN).

Dr. James Blanchard, executive director of the Institute for Global Public Health in the Rady Faculty of Health Sciences at UM, believes all women and children deserve the same health opportunities that many in Canada take for granted.

“Each year there are over 5.5 million babies born in Uttar Pradesh, and so improving the outcomes for mothers and their newborns and children in that state is one of the most important public health initiatives in India and globally,” he says.

In order to improve survival rates, programs like nurse mentoring and home visits where new mothers learn ways to properly feed their newborns from UP TSU-trained nurses can be life-changing.

For Vandana Singh, a nurse at DCH Manjhanpur, the continuous mentoring support she received through the program helped ensure she and other staff nurses were able to manage maternal and neonatal issues at the facility.

“This has increased my confidence in managing maternity complications independently,” she says.

Singh and other UP TSU-trained midwives and frontline workers are also able to support new mothers in their own homes by performing regular assessments and educating mothers on newborn care. The mentoring programs initially designed and supported through the partnership between the UM team and the Government of Uttar Pradesh is now being funded and managed by the government of Uttar Pradesh across the state. It has improved the overall quality of care in health care facilities and communities.

Long serving doctors are noting the difference as well, not only in the improvement of clinical care from the hospital staff, but also in the availability and quality of equipment and other resources within the health care facilities.

This “has led to optimum functioning of the facility, thus serving the community with the right kind of services at the right time, resulting in a positive and safe birthing experience,” says Dr. Ravindra Singh, Rtd., the chief medical superintendent at the District Women’s Hospital in Hardoi, Uttar Pradesh.

All lives have equal value is the driving force behind the investment decisions of the Bill & Melinda Gates Foundation. Advanced programming, training and policies guided by GoUP through UP TSU and supported by UM researchers that prioritize the health of pregnant women and their children have led to the decrease of neonatal mortality rates to 36 per 1,000 live births in 2019. This forms the basis for this most recent investment in the ongoing partnership with the UM and the Government of Uttar Pradesh.

“With this new investment, we will be supporting the government in scaling up critical initiatives across the state and optimizing programs at the community level, within health facilities and through health systems strengthening,” says Dr. Marissa Becker, UM associate professor, Department of Community Health Sciences and director of technical collaborations at the Institute for Global Public Health.

View the video to see the women and children in Uttar Pradesh that are impacted by this partnership.

A total of more than $12 million was awarded in the form of project and bridge grants, with study durations ranging from one to five years.

“Congratulations to all the dedicated UM researchers who were successful in this Spring 2021 funding competition,” said UM Vice-President (Research and International) Dr. Digvir Jayas.

“These professors have shown leadership in their fields and are advancing knowledge in several important areas of Indigenous health, as well as in illnesses such as kidney disease, heart disease, HIV, diabetes, cancer and psychiatric disorders.”

The UM project that received the largest grant, more than $1.9 million over five years, is titled Qanuinngitsiarutiksait.2: Developing tools for the wellness and safety of Inuit.

DR. JOSEE LAVOIE

Led by Dr. Josée Lavoie, professor of community health sciences and director of Ongomiizwin Research, the project builds on a previous study of service use by the thousands of Inuit from Nunavut who come to Manitoba to access services.

The new study will focus on how Inuit concepts of wellness can be used to create healing programs in Winnipeg that reflect Inuit values. The researchers plan to develop and implement several programs, such as one tailored to the needs of Inuit families involved with Child and Family Services.

A five-year grant of more than $1.4 million was awarded to the project Oral microbiome and caries risk in young First Nations and Métis children in Manitoba.

DR. ROBERT SCHROTH

A team led by Dr. Robert Schroth, professor of preventive dental science in the Dr. Gerald Niznick College of Dentistry and researcher with the Children’s Hospital Research Institute of Manitoba (CHRIM), will examine the dental microbiome that is associated with the severe form of baby-tooth decay that affects many First Nations and Métis preschoolers.

The aim is to understand why only some dental microorganisms cause tooth decay, and the environmental factors that may influence this process.

Here’s a look at the other funded studies and lead investigators. More information on the studies and research teams is available here.

Dr. Marissa Becker, associate professor, medical microbiology & infectious diseases, Max Rady College of Medicine

Grant: $200,000 (two years)

Becker’s team will study sexually transmitted and blood-borne infections (STBBI) among military personnel in Ukraine, examining how they contribute to broader STBBI epidemics amid the armed conflict in that country.

Dr. David Collister, assistant professor, internal medicine, Max Rady College of Medicine

Grant: $321,300 (three years)

Collister seeks to determine which uremic toxins are responsible for individual disease symptoms in advanced chronic kidney disease, and which symptoms respond to dialysis. The findings will inform dialysis decision-making.

Dr. Kevin Coombs, professor, medical microbiology & infectious diseases, Max Rady College of Medicine

Grant: $100,000 (one year)

Coombs will examine human cells’ susceptibility to the Zika virus, which is transmitted by a mosquito that is becoming known in Canada. He aims to understand how cellular genes and proteins work to allow or inhibit Zika growth.

Dr. Sanjiv Dhingra, associate professor, physiology & pathophysiology, Max Rady College of Medicine; principal investigator, Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre

Grant: $960,076 (five years)

Dhingra’s study relates to the potential of using transplanted stem cells from healthy donors to treat heart disease. He will investigate why transplanted stem cells are ultimately rejected by the host’s immune system, and how to prevent this.

Dr. Vernon Dolinsky, associate professor, pharmacology & therapeutics, Max Rady College of Medicine; researcher, CHRIM

Grant: $822,376 (five years)

Dolinsky’s team has found that the offspring of mothers who had gestational diabetes are at risk of later heart failure. His study will investigate the role of a cellular protein that could prevent damage to the heart and allow it to pump better.

Dr. Krista Hardy, assistant professor, surgery, Max Rady College of Medicine

Grant: $470,475 (four years)

Hardy aims to better understand the experiences of Indigenous patients who undergo bariatric surgery in Manitoba as a treatment for obesity. Her project will incorporate and assess Indigenous healing and wellness practices in bariatric surgery care.

Dr. Richard Keijzer, professor, surgery, Max Rady College of Medicine; researcher, CHRIM

Grant: $233,324 (three years)

Keijzer’s team has created a database of more than 750 Manitobans who were born with a congenital anomaly that required surgery at birth. By linking this to population data, the team will conduct a follow-up study of the patients’ medical, educational and socio-economic outcomes.

Grant: $749,700 (five years)

Keijzer will also lead an international team of experts on congenital diaphragmatic hernia (CDH) to determine the role of circular RNAs in these infants’ abnormal lung development. The results will help to better predict outcomes in babies with CDH.

Dr. Dylan MacKay, assistant professor, community health sciences, Max Rady College of Medicine

Grant: $100,000 (one year)

MacKay will enrol patients with chronic kidney disease in a one-year, randomized study comparing methods of reducing dietary acid. Half the patients will take baking soda pills, while the other half will have fruits and vegetables delivered to them to reduce acid through diet.

Dr. Lyle McKinnon, associate professor, medical microbiology & infectious diseases, Max Rady College of Medicine; researcher, CHRIM

Grant: $300,000 (three years)

McKinnon’s team has previously found that vaginal inflammation increases a woman’s risk of becoming HIV-infected if exposed. His study focuses on regulatory T cells and their potential to control female genital inflammation as an HIV prevention strategy.

Dr. James Nagy, professor, physiology & pathophysiology, Max Rady College of Medicine

Grant: $742,050 (five years)

Nagy’s study builds on his previous research on how nerve cells in the brain communicate at electrical synapses, how protein components function in this transmission, and how malfunctioning of these mechanisms contributes to neurological disorders.

Dr. Marcus Ng, associate professor, internal medicine, Max Rady College of Medicine

Grant: $548,890 (five years)

Ng will analyze data from patients with epilepsy to compare the brain zone of epileptic activity during rapid eye movement sleep, other stages of sleep, and wakefulness. Better mapping of where seizures arise could allow more patients to undergo life-changing neurosurgery.

Dr. Tabrez Siddiqui, associate professor, physiology & pathophysiology, Max Rady College of Medicine

Grant: $983,026 (five years)

Siddiqui will investigate, in mice, how a type of altered biochemical signaling affects the brain, producing deficits such as those in autism and schizophrenia. The goal is to increase understanding of neuropsychiatric disorders so that drug targets can be identified.

Dr. Jörg Stetefeld, professor, biochemistry, Faculty of Science; Canada Research Chair in structural biology and biophysics

Grant: $742,050 (five years)

Stetefeld will pursue a molecular study of connective tissue growth factor (CTGF), a protein involved in cancerous tumor development and tissue fibrosis. He aims to develop new therapeutic targets based on understanding the role of CTGF.

Dr. Julia Uhanova, associate professor, internal medicine, Max Rady College of Medicine

Grant: $573,751 (two years)

Uhanova will explore whether adherence to a traditional First Nations land-based diet decreases the severity of non-alcoholic steatohepatitis, an aggressive form of fatty liver disease. This inflammatory disease has a high prevalence among First Nations.

Dr. Jude Uzonna, professor, immunology, Max Rady College of Medicine

Grant: $990,676 (five years)

Uzonna’s study focuses on how the body maintains immunity after recovery from leishmaniasis, a parasitic disease. Understanding factors that regulate the antigen-specific memory response to the disease will aid progress toward a vaccine.

Dr. Kristy Wittmeier, associate professor, pediatrics & child health, Max Rady College of Medicine; researcher, CHRIM

Grant: $240,976 (two years)

Building on her previous research, Wittmeier will study knowledge-sharing networks in child development and rehabilitation in Canada. Her team will make recommendations to improve these networks to better serve children’s needs.

And the University of Manitoba is there.

Dr. Marissa Becker [MD/99] is an associate professor in the department of community health sciences and the department of medical microbiology and infectious diseases within the Rady Faculty of Health Sciences. She is also director of technical collaboration for the Institute for Global Public Health (IGPH).

In Delhi, her role with IGPH supports UM projects in India.

Dr. Marissa Becker

UM has been working in India since the early 2000s, beginning with work on HIV prevention and care led by Drs. James Blanchard and Stephen Moses. Since then, the work has expanded to maternal and child health, nutrition, family planning, and health systems strengthening, as well as work on infectious disease surveillance and tuberculosis.

Becker notes: “We currently work in Delhi, Madhya Pradesh, Karnataka, and Uttar Pradesh. Our biggest program is in Uttar Pradesh in partnership with India Health Action Trust, where we work with the local government to run a Technical Support Unit (TSU) on maternal and child health. We support the government in achieving its health goals in the areas of maternal, newborn and child health, nutrition, family planning and health system strengthening.”

The UM TSU team, funded by the Bill and Melinda Gates Foundation, is large, with about 1,200 people, mostly local residents, providing technical support for programs at the state level and local community level. They work with frontline workers, health care providers, health systems, data, and they design and implement surveys.

Becker explains: “The TSU team is headed by Dr. Vasanth Kumar who has an appointment with UM community health sciences, as do many of our senior core team members from India.

In addition to the team in India, we have a number of UM faculty who support the work, including Drs. Stephen Moses, Maryanne Crockett, Rob Lorway, Shiva Halli, Lisa Avery, Ties Boerma, and BM Ramesh. Dr. James Blanchard is lead of the TSU team in Uttar Pradesh. A number of our postdoctoral students and other graduate students are also engaged.”

When the pandemic hit India a year ago, UM researchers were asked by the government of Uttar Pradesh to help provide support in dealing with the pandemic. They created and implemented a multi-pronged strategy using data for decision making and helped establish a very comprehensive COVID-19 surveillance system for the state. In addition, they provided training and support to front line workers in the community around prevention measures and community surveillance. Further, they supported forecasting for strategic planning of equipment and supplies and helped in conducting COVID seroprevalence studies.

With the tidal wave of COVID cases today, the UM team is working with the government to help address the very serious and very dire oxygen shortages.

Becker says: “The situation here is very difficult- and the health system in many areas across the country is overwhelmed- the impact is immense. The health care facilities are full and many have insufficient equipment and supplies. Families are really struggling. On top of their trying to cope with loved ones that are sick, many are incurring significant financial costs — catastrophic out of pocket expenses.”

She explains that the vaccination program in India started out strong but unfortunately the total proportion of the population immunized was still very low when this latest wave hit.

“I fear that the country will have a difficult time in catching up quickly enough to address this current wave,” she says. “In the meantime, other prevention measures have been put back in place with lockdowns in many states across the country. We are also now seeing many countries step up with support now, but I’m worried about the shift to more cases in the rural areas and also to neighbouring countries in the region in which we are seeing increases in cases — and these countries are also facing shortages of vaccines.”

Becker admits that the pandemic is affecting her personally to some extent.

“Many of our team members and their families have been affected,” she says sadly. “Many friends and colleagues are trying desperately to help their loved ones find a bed, find medicines, to provide care to them. You can hear people’s frustrations, grief and exhaustion when you speak with them.”

Becker believes that the UM community should be proud of the UM response in India. “Not only has our team played an active role in addressing the pandemic, but it has also tried to help the state of Uttar Pradesh ensure that many of the consequences of the pandemic, such as interrupted health care services, have been mitigated. We have worked very hard to ensure the quick and safe return of full services for ensuring maternal and child health.”

Finally, Becker appeals to all of us in taking the situation seriously.

“Sitting here in Delhi now, I want to convey that this is a global emergency and we need to treat it as such — with upmost speed in rolling out vaccination programs, and ensure access to all- within our own country, but also globally,” she explains. “We must learn from this pandemic in effort to prevent and better address future epidemics, and mitigate their very significant consequences, including the tremendous health,  social and financial impacts.”

She adds: “As academics, we need to keep making sure we are using science and appropriate data to inform our response to the pandemic. It’s so critical right now. I think our projects here demonstrate the use of data for decision making.”

Molecular epidemiological tools are gaining popularity among researchers as they can identify previously unlinked transmissions. The anonymized data can offer many insights, but the data is far removed from the lived experiences of those hindered by the disease, so any program developed from this data may not fit the “real world” circumstances of those needing help.

Robert Lorway, Co-Principal Investigator and professor of community health sciences and Canada Research Chair in Global Intervention Politics and Social Transformation.

Lyle McKinnon, Co-Principal Investigator and an associate professor in medical microbiology and infectious disease.

But for the UM team, led by Lyle McKinnon, an associate professor in medical microbiology and infectious disease in the Rady Faculty of Health Sciences, the big question is the ethical questions that emerge from using such tools, and how these can be harnessed to guide HIV programs. 

“Do these new powerful techniques for identifying transmission patterns represent a major breakthrough to effectively tackle HIV epidemics, or do they signify the emergence of a highly intrusive surveillance regime in HIV science,” he asks.

This new study, which received $250,000 in support from Canada’s New Frontiers in Research Fund – Exploration, opens a critical and engaged dialogue with a vibrant local activist community in Kenya, Nairobi, and will offer insight into the potential uses and anticipated abuses of using such information to sharpen the focus of HIV epidemic prevention. The outcome of this process holds major importance to the development of policy frameworks that will guide the next generation of the global response.

The UM team has used such molecular tools to analyze several hundred HIV sequences within a large sex worker prevention program and noted several large, mixed transmission networks. Now, with co-lead Robert Lorway, they are directly engaging communities of male and female sex worker activists living in Nairobi, Kenya, in a critical knowledge exchange process. This will answer how, or if, these data can be ethically used to inform existing programs.

The UM has long been a trailblazer in many areas of HIV/AIDS research, including the search for a vaccine against its spread, and this project builds upon this legacy of community partnership to bolster global public health.

This study will draw upon a community based participatory approach employed by feminist and postcolonial scholars. Its multidisciplinary team of basic and social scientists, policy-makers, and local community health activists will 1) work through lay technical summaries of the molecular data to explore the possibilities and limitations of employing network interventions, 2) co-design and test, under carefully controlled conditions, a targeted pilot intervention that combines molecular network data with community knowledge and 3) critically assess and identify the emergent ethical issues, advantages and disadvantages of the tested intervention (when compared to conventional approaches).

Opening up a critical and engaged dialogue with a vibrant local activist community, will offer insight into the potential uses and anticipated abuses of using such information to sharpen the focus of HIV epidemic prevention. The outcome of this process holds major importance to the development of policy frameworks that will guide the next generation of the global response.

Research team includes:

• Robert Lorway – Co-Principal Investigator, Professor and Canada Research Chair in Global Intervention Politics and Social Transformation, Community Health Sciences, Max Rady College of Medicine
• Souradet Shaw – Co-Applicant, Assistant Professor and Canada Research Chair in Program Sciences and Global Public Health, Community Health Sciences, Max Rady College of Medicine
• Parinita Bhattacharjee – Co-Applicant, Senior Technical Advisor, Partners for Health and Development in Africa, Technical Support, Kenya
• Joshua Kimani – Co-Applicant, Clinical Director, Partners for Health and Development in Africa, Key Populations Research, Kenya
• Marissa Becker – Co-Applicant, Associate Professor, Community Health Sciences, Max Rady College of Medicine
• Marianne Mureithi – Co-Applicant, Lecturer, University of Nairobi, Medical microbiology, Kenya

“India has been trying hard to address the pandemic, but the public health system is not as well equipped as it needs to be,” says Dr. Marissa Becker, an infectious disease specialist and associate professor of community health sciences, internal medicine and medical microbiology.

Becker, a UM alumna in medicine, works for the UM Centre for Global Public Health (CGPH), which is part of the Rady Faculty of Health Sciences. She, her husband and their two sons have lived in India for the past two years.

On March 23, with just five hours’ notice to pack up and catch a departing flight, they followed the Canadian government’s advice to return to Manitoba. India is now under a nationwide lockdown to limit the spread of the coronavirus.

Becker is now in post-travel self-isolation at a family member’s house in Winnipeg. She is determined to do as much as she can to keep supporting India’s pandemic fight via email, phone and videoconference.

“I had very mixed emotions about leaving,” she says. “I hope to get back as soon as I can. We’re all in this together.”

The state of Uttar Pradesh in northern India has a population of roughly 223 million. The University of Manitoba leads the Uttar Pradesh Technical Support Unit, funded by the Bill & Melinda Gates Foundation.

The unit, established in 2013, employs about 1,200 people. It works in partnership with the India Health Action Trust to support the Uttar Pradesh government in strengthening maternal and child health, nutrition and family planning.

A number of faculty members from the CGPH, including Dr. James Blanchard, director of the CGPH, and Dr. Stephen Moses, associate director, travel regularly to Uttar Pradesh. All have left India for the time being.

In light of the pandemic crisis, Becker says, the Technical Support Unit has responded to the Uttar Pradesh government’s request for help with urgent priorities such as assessing medical supplies and health facility preparedness, creating a state-wide command centre and setting up a call centre. 

“We’re applying our health-system expertise to analyzing data on things like the supply of hospital beds, ventilators and personal protective equipment for health-care providers,” Becker says.

“We’re developing a phone line similar to the Health Links line in Manitoba, where people can call with questions related to COVID. A key concern is making sure people in the rural and remote areas can access the call centre and get information in a timely manner.”    

The unit is also producing guidelines for health-care facilities on procedures such as infection control and managing patients with COVID-19.    

The professor has high praise for the Technical Support Unit team and health workers on the ground in Uttar Pradesh. She herself is based in Delhi, a city of more than 20 million people.

She works in a six-person office that supports all the health projects in India in which UM is involved, including HIV units in Delhi and the state of Karnataka, and a new unit to support public health in the state of Madhya Pradesh.

Becker hopes to play a part in Manitoba’s pandemic-fighting effort as soon as she’s out of isolation. Meanwhile, her thoughts are with her friends and colleagues in locked-down India. The country’s dense population, widespread poverty and inequitable access to health care pose daunting challenges during the pandemic and lockdown, she says.       

“I think of all the people who are daily wage labourers, not being able to go to work and buy food,” she says. “Crises like this always hit the most vulnerable the hardest.

“Ever since the U of M started to partner in improving public health programs in India nearly 20 years ago, reaching those who are most vulnerable has been one of our core principles.”