So on Monday I spoke a little bit about MSF’s Scientific Day (to be held this Friday, May 25th 2012). Today, I’m welcoming Petros Isaakidis, MD, PhD, to the blog to talk about his experiences in India with HPV. Petros is a medical epidemiologist. He has worked as a clinician for the National Health System in various parts of Greece and as an epidemiologist for the Center for Diseases Control and Prevention, in Athens. He was a biological disasters planner during the Athens Olympic Games in 2004, and in-charge of infectious diseases surveillance and outbreak investigations. He has been volunteering and working for humanitarian organizations, mainly Médecins Sans Frontières (MSF) in Zimbabwe, Gaza Strip & West Bank, Kenya, Cambodia, Thailand, Lesotho and India. During this period he coordinated medical projects, especially large scale HIV and TB projects and supported evidence generation through field-based operational research projects.
Hi Petros! Welcome to Mr Epidemiology! Why don’t we start with you telling your audience who you are and where you work?
Hi! Thanks for the hospitality! I’m a Medical Epidemiologist (which is only slightly different from a skin doctor…) and I am currently with Médecins Sans Frontières (MSF) in Mumbai, India working as Operational Research Focal Person.
How did you end up with Médecins sans Frontières? Was this always part of “the plan”?
When I was a medical student I volunteered in a refugee camp in Zimbabwe/Mozambique borders with a small NGO. I think I got an “itchy-feet” infection over there. Then, just when I graduated, I met this “veteran” MSF expatriate who had fascinating stories to tell. This time the stories were far more professional than my fun stories with this small NGO. I think this guy was terribly infectious and contagious. Since then I have been getting re-infected, cross-infected, super-infected, you-name-it. There was no “plan”; there were germs, there were vectors and there was this very, very weak host… (Mr Epid: For this answer, Petros wins the inaugural Mr Epidemiology Pun Award)
So your study was titled “Prevalence and incidence of human papillomavirus infection, cervical abnormalities, and cancer in a cohort of HIV-infected women in Mumbai, India: a 12-month follow-up.” How many people do HPV and HIV affect in India?
The adult HIV prevalence in India during the last 5 years is about 0.4%. In some groups like sex workers, men who have sex with men and injectable drug users is much higher. Sounds small overall, but we are talking about India here; more that 2.5 million people are estimated to be infected with HIV. As for HPV, approximately 8% of women are infected. I let you do the math.
In a nutshell, what did you do?
This was not a study but documentation of a program. We decided to offer the full package of sexual/reproductive health services to all HIV-infected women attending our HIV-clinic in Mumbai. Cervical cancer screening is important in this population considering that it is at higher risk for cervical intraepithelial neoplasia (CIN) and cancer compared to the general population. We found a partner (Preventive Oncology Department at TATA Memorial Hospital, Mumbai) and we started implementing the screening, including treatment of sexually transmitted infections, CIN and cancer. We decided to document and share our experiences.
What was the biggest barrier you faced doing your research? I imagine accessing these women was particularly difficult?
We faced few, minor problems. Mumbai is a metropolis with state-of-the-art facilities so if you provide the resources you can get excellent services. The problem is resources and access to such services, considering the extreme poverty and social disparities, Mumbai is very well known for. In my previous experience in Cambodia, where we tried to do a similar program, we had huge challenges to face; from availability of reliable cytology and pathology, even in the capital Phnom Penh, to treatment options on offer, to stigma and discrimination and even denial from surgeons to operate HIV-infected women with cancer. We finally did it but it was somehow hard. In Kenya, few years earlier, we haven’t even managed to get a single specimen to send to Nairobi for cytology… In all countries though, women were really willing to get the screening, with very few denials. Something to remember is that HIV-infected women are often enrolled in care so it is highly likely that loss-to-follow-up (“traditionally” high in such screenings) will be low.
So what’s next for you? What do you do with these findings?
We will continue with our annual screening. We would like to contribute to the discussion on the optimal interval between screenings, especially in resource limited settings. We found that there is still little published out there on the subject of HPV-infection and cancer treatment among HIV-infected women in resource constrained settings and this was surprising and disappointing. We will present the same abstract in the AIDS conference in Washington in few months. We are currently writing-up a full paper, which we plan to submit for peer-review and further advocate for offering regular screening and treatment to all HIV-infected women.
What advice do you have for those interested in working for MSF and in public health?
Do not watch cooking reality shows, do not just read cook-books and recipes (like this very piece) written by amateur cooks. Get into the kitchen and get your hands dirty. The odds are you will come up with real food that is yummy and nutritious to others….
Thanks Petros for your time! Check back tomorrow for another interview with Margriet Den Boer, who went studied leishmaniasis in Bangladesh!