2016 Update: A Lasting Solution for Healthcare in Mozambique

Mozambique highlighted on a map of Africa There is a critical shortage of practicing doctors and medical educators in Mozambique, where the life expectancy is less than 42 years and the rate of HIV infection in adults is 16%. UC San Diego is teaming with the nation’s flagship medical school to create a long-term solution.

Mozambique’s Universidade Eduardo Mondlane (UEM) and UCSD have won a five-year, $12.5-million award from the U.S. Medical Education Partnership Initiative (MEPI). The project will strengthen the nation’s medical education system by building infrastructure in several ways.


“We hope this will be a demonstration project for the rest of Africa.”
— Dr. Robert Schooley


Dr. Emilia Virginia Noormahomed, a co-investigator on the UCSD-UEM MEPI project.UEM’s principal investigator is Emilia Virginia Noormahomed, MD, PhD, a former dean of the UEM School of Medicine. Dr. Noormahomed (pictured at left) is now Assistant Professor of Parasitology at UEM and Assistant Professor of Medicine at UC San Diego.

Sam Patel, MD, Professor of Medicine at UEM and UC San Diego, is a co-investigator. In the photo below, he is pictured on the right.

View photo captions and credits

Dr. Bill Detmer, at left, demonstrates iPad mobile digital device preloaded with medical programs for doctors’ use in the hospital. Dr. Manuel Joaquim Tomás is at center and Dr. Sam Patel at right. Sam Patel, M.D., co-investigator on the MEPI project, is Professor of Medicine at UEM and UCSD. Bill Detmer, M.D., M.Sc., a MEPI project consultant, is Assistant Adjunct Professor of Clinical Informatics at the University of Virginia and President and Chief Executive Officer of Unbound Medicine.

MEPI is a joint initiative of the National Institutes of Health and the President’s Emergency Plan for AIDS Relief (PEPFAR). Under the MEPI program, UEM receives the bulk of the funding and uses it to build capacity in medical training, research, and technology.

A smaller amount of funding comes directly to UC San Diego, supporting time and travel for the partners and mentors who will help UEM meet its goals.

M. Wilson Tilghman, M.D., UCSD’s on-site faculty member in Mozambique, consults with a UEM internal medicine resident at a patient’s bedside. Instituting the use of wirelessly-accessed medical reference material in the hospital is one of the UCSD-UEM project goals.“This is an experiment in medical education for UEM and for the U.S. government,” said Robert “Chip” Schooley, MD, who is coordinating the UC San Diego side of the project. “It puts the funding into the hands of the African universities and allows them to invest it in ways that are beneficial to them.”

Dr. Schooley is Professor and Academic Affairs Vice Chair in the Department of Medicine and Chief of the Division of Infectious Diseases.

“I’m hopeful this will become a model for other kinds of aid,” he said.

Dr. Schooley and colleague Constance Benson, MD, have long experience in partnering with Mozambique and other African nations, and they have collaborated with Dr. Noormahomed in research projects for several years. Dr. Benson is Professor of Medicine, Director of the UC San Diego Antiviral Research Center, and Director of the Fellowship Program in Infectious Diseases.

The UEM-UCSD MEPI project expands some of the educational efforts that have been going on since July 2009 in the Internal Medicine Residency Program’s Global Medicine elective.

UC San Diego’s visiting faculty and residents have helped UEM adopt academic medical practices such as morning report and teaching conferences that strengthen the educational program.

MEPI biomedical informatics team members at October conference at UEM in Maputo.

MEPI biomedical informatics team members at October conference at UEM in Maputo.

The MEPI partnership relies heavily on biomedical informatics to accomplish its goals. This component of the program is led by Lucila Ohno-Machado, MD, PhD, Professor of Medicine and Chief of UC San Diego’s Division of Biomedical Informatics. The division will provide expertise for the partnership’s information technology projects.

Dr. Kathy Promer, a 2013 graduate of the UC San Diego Internal Medicine Program, is the current infectious diseases fellow at UC San Diego on rotation at UEM’s Maputo Central Hospital. In the photo below, she is standing, second from the right.

Dr. Kathy Promer (standing, second from the right), 2013 Graduate of the UCSD Internal Medicine Program and current infectious diseases fellow at UCSD on rotation at UEM’s Maputo Central Hospital.

Smartphones and iPad mobile digital devices have been deployed on the wards at Maputo Central Hospital, UEM’s primary teaching hospital and the only tertiary care center in Mozambique. With these devices, the Mozambican doctors are able for the first time to consult online medical literature at a patient’s bedside. Soon they will have immediate access to data generated by the hospital’s clinical laboratories.

“These efforts really have changed the character of the residency program at Maputo Central Hospital,” said Dr. Schooley.

Through training and partnership with UC San Diego, UEM will also increase its capacity to do operational, epidemiological, translational and clinical research. Another program goal calls for UEM to set up a biomedical informatics infrastructure and connect with SEACOM, the new fiber optic broadband internet service in South and East Africa.

Students in UEM medical school class.UEM will also take steps to enhance its support of two new medical schools recently established by the Mozambican government in Nampula and Tete. These two new medical schools were launched in the past 3 years to address the profound shortage of physicians in the country.

Another key UC San Diego figure in the project is Stephen Bickler, MD, who will work to improve the nation’s surgical capacity in rural areas via a linked MEPI project, “UEM-UCSD Surgery Partnership.” Dr. Bickler is Associate Professor of Surgery and Pediatrics.

A number of other UC San Diego faculty members will contribute to the MEPI effort as well.

Medical school class   UCSD internal medicine resident Dr. Bethany Karl

Above left, a medical school class at Universidade Eduardo Mondlane. Right, Dr. Bethany Karl on rotation at UEM’s Maputo Central Hospital. Dr. Karl graduated from the UC San Diego Internal Medicine Program in 2010 and is currently a nephrology attending. Photo courtesy of Robert T. Schooley, MD

Project leaders expect to double the number of graduating doctors in Mozambique in the next 10 years. They also hope to inspire more doctors to devote their careers to medical education.

With a greater number of highly-trained doctors and a better infrastructure to support them, Mozambique will increase its capacity to deliver health care to its citizens and to fill the faculties of two new medical schools in Nampula and Tete.

The doctors training today in Mozambique will be the specialists, medical school faculty members, and government Ministry of Health policymakers of the future.

“We hope this will be a demonstration project for the rest of Africa,” Dr. Schooley said.

Read the UC San Diego News press release about our MEPI project.

Read about the project in “The Great Beyond,” Nature magazine’s blog
for breaking news in the sciences.


Photo Captions and Credits:

Dr. Emilia Virginia Noormahomed, co-principal investigator on the UCSD-UEM MEPI project.Dr. Emilia Virginia Noormahomed, co-principal investigator on the UC San Diego-UEM MEPI project. Photo courtesy of William M. Detmer, MD, MSc.

Drs. Detmer, Tomás, and PatelDr. Bill Detmer, left, demonstrates iPad mobile digital device preloaded with medical programs for doctors’ use in the hospital. Dr. Manuel Joaquim Tomás is at center and Dr. Sam Patel at right. Sam Patel, MD, co-investigator on the MEPI project, is Professor of Medicine at UEM and UC San Diego. William M. Detmer, MD, MSc, a MEPI project consultant, is Assistant Adjunct Professor of Clinical Informatics at the University of Virginia and President and Chief Executive Officer of Unbound Medicine. Photo courtesy of Dr. Detmer.

Dr. Tilghman and Mozambican residentM. Wilson Tilghman, MD, UC San Diego’s on-site faculty member in Mozambique, consults with a UEM internal medicine resident at a patient’s bedside. Instituting the use of wirelessly-accessed medical reference material in the hospital is one of the UC San Diego-UEM project goals. Photo courtesy of Robert T. Schooley, MD.

MEPI biomedical informatics team members at October conference at UEM in Maputo. MEPI biomedical informatics team members at October conference at UEM in Maputo. From left: Lucila Ohno-Machado, MD, PhD; Eli Aronoff-Spencer, MD, senior postdoctoral fellow in infectious diseases at UC San Diego; Eng. David Bila, Network Director for the Informatics Center at UEM; Heimar de Fátima Marin, RN, PhD, Professor of Health Informatics at Universidade Federal de São Paulo; and Eng. Francisco Mabila, Director of the Informatics Center at UEM. Photo courtesy of William M. Detmer, MD, MSc.

Dr. Kathy Promer (standing, second from the right), is a 2013 graduate of the UC San Diego Internal Medicine Program and is the current infectious diseases fellow at UC San Diego on rotation at UEM’s Maputo Central Hospital.

Students in a medical school class at UEM.Students in a medical school class at UEM. Photo courtesy of William M. Detmer, MD, MSc.

A medical school class at UEM.A medical school class at UEM. Photo courtesy of William M. Detmer, MD, MSc.

UCSD internal medicine resident Dr. Bethany Karl on rotation at UEM’s Maputo Central Hospital.UC San Diego internal medicine resident Dr. Bethany Karl on rotation at UEM’s Maputo Central Hospital. Photo courtesy of Robert T. Schooley, MD.

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UC San Diego Students Design Low-Cost HIV Viral Load Monitoring System for Tijuana, Mexico

A group of students from the Jacobs School of Engineering at the University of California San Diego will spend the summer trying to curb the HIV epidemic in Tijuana, Mexico.

Two teams from UC San Diego’s Engineering World Health (EWH) student organization and Global TIES program are combining forces this summer to bring a device they created to monitor viral load in HIV patients to a clinical setting in Tijuana, Mexico for testing. … Read the full story from the UC San Diego Newsroom


UC San Diego Health Department of Medicine physicians Davey Smith and Matt Strain are advising both teams of students.

Dr. Davey Smith

Dr. Davey Smith

Davey Smith, MD, MAS, is Professor of Medicine in the Division of Infectious Diseases. He co-directs the UC San Diego Center for AIDS Research (CFAR) and directs the CFAR’s Translational Virology Core.

Matt Strain, MD, is Assistant Professor of Medicine and physician in the Genomics and Sequencing Core at the UC San Diego CFAR.

Frontiers of Innovation Fellows to Showcase Research Addressing Global Challenges at Symposium

November 25, 2015

After a study abroad trip to Tanzania as an undergraduate, Julie Bergmann knew that she wanted to pursue a career in public health. Now a doctoral candidate in global health at UC San Diego, Bergmann is conducting research in Uganda to assess health care barriers for HIV-exposed infants. Bergmann is part of the inaugural UC San Diego Frontiers of Innovation Scholars Program cohort and will present her research at the first annual FISP Symposium on Friday, Nov. 20. … Read the full story from the UC San Diego Newsroom


Julie Bergmann, MHS, is a postdoctoral fellow in the Division of Global Public Health. She holds a master’s degree in International Health Systems from Johns Hopkins Bloomberg School of Public Health.

Her research interest is in maternal and child health in sub-Saharan Africa, with a focus on developing practical and effective ways to address the needs of the vulnerable populations.

In a research project in Kenya, she is examining the couple-level obstacles, particularly in the male perspective, to the use of female contraception. Family planning is the most effective way to eliminate HIV-related maternal deaths and prevent mothers from transmitting HIV to their children.

High Rates of Violence, HIV Infection for Adolescents in Sex Trade on U.S.-Mexico Border

Researchers at University of California, San Diego School of Medicine report that more than one in four female sex workers in two Mexican cities on the U.S. border entered the sex trade younger than age 18; one in eight before their 16th birthday. These women were more than three times more likely to become infected with HIV than those who started sex work as adults. They were also three times more likely to be violently coerced to engage in sex with male clients and seven times less likely to use a condom during their first month in the sex trade.

The study is published August 4 in the Journal of the American Medical Association. … Read the full story from the UC San Diego News Center


The study comes from the Division of Global Public Health in the Department of Medicine. Jay G. Silverman, PhD, professor of medicine and director of research for the Center on Gender Equity and Health, is lead author.

The senior author is Kimberly Brouwer, PhD, associate professor of medicine and leader in the Scientific Working Group on HIV Prevention at the UC San Diego Center for AIDS Research.

Read the article full text (UC San Diego only)

New Drug Combination Treats Hepatitis C Patients Also Infected with HIV

Novel treatment has 97 percent success rate in co-infected patients —

Roughly 20 to 30 percent of patients with hepatitis C virus (HCV) are also infected with human immunodeficiency virus type 1 (HIV). Both blood-borne viruses share the same modes of transmission, but many HCV medications currently have significant limitations due to adverse interactions with HIV treatments. Researchers at University of California, San Diego School of Medicine report a new combination that effectively treats HCV in patients co-infected with HIV. … Read the full story from the UC San Diego News Center


David L. Wyles, MD, is lead author of the New England Journal of Medicine article that reports the results of the multi-center study. Dr. Wyles is associate professor of clinical medicine in the Division of Infectious Diseases.

Read the article online:

Wyles D.L., Ruane P.J., Sulkowski M.S., et al. Daclatasvir plus Sofosbuvir for HCV in Patients Coinfected with HIV-1. New England Journal of Medicine July 21, 2015, 10.1056/NEJMoa1503153.  Free full text

At the Nexus of Substance Abuse and HIV

UC San Diego Researcher Wins Major Award to Study New Treatments and Preventions —

Dan Werb, PhD, an internationally noted epidemiologist at University of California, San Diego School of Medicine, has been named one of four inaugural recipients of the Avenir Award, a prestigious $1.5 million research grant from the U.S. National Institute on Drug Abuse, part of the National Institutes of Health (NIH). … Read the full story from the UC San Diego Newsroom

Binational Police Program in Tijuana Targets HIV Reduction

Effort also aims to improve safety of officers —

Research consistently shows that policing practices, such as confiscating or breaking needles, are key factors in the HIV epidemic among persons who inject drugs. Police officers themselves are also at risk of acquiring HIV or viral hepatitis if they experience needle-stick injuries on the job — a significant source of anxiety and staff turn-over.

A binational team from the University of California, San Diego School of Medicine and the U.S.-Mexico Border Health Commission, Mexico Section has launched a new research project aimed at promoting prevention of HIV and other blood-borne infections. The effort is led by Steffanie Strathdee, PhD, professor and director of the UC San Diego Global Health Initiative, Leo Beletsky, JD, MPH, associate professor, and Gudelia Rangel, PhD, deputy general director for migrant health and executive secretary of the Mexico Section of the Mexico-United States Border Health Commission, in partnership with the Tijuana Police Department and Police Academy. The binational team will offer and evaluate Proyecto ESCUDO (Project SHIELD), a police education program designed to align law enforcement and HIV prevention in Tijuana. … Read the full story from the UC San Diego Newsroom


Dr. Jamila Stockman to Receive Linda Saltzman New Investigator Award

Dr. Jamila Stockman

Dr. Jamila Stockman

Jamila Stockman, PhD, MPH, has been selected to receive the Linda Saltzman New Investigator Award, which recognizes a single outstanding new investigator in the field of gender-based violence and health.

Dr. Stockman, an infectious disease epidemiologist, is assistant professor in the Division of Global Public Health. She focuses her work on intimate partner violence (IPV) and substance abuse among low-income, underserved, vulnerable women.


Read the UC San Diego Newsroom press release


Said Dr. Steffanie Strathdee, chief of the Division of Global Public Health, “This is, without question, the most prestigious scholarly award in this field of study. Dr. Stockman’s selection indicates that she, at a very early stage in her career, is recognized as a national leader in this area.

“It is a true mark of excellence for the Division of Global Public Health, the Department of Medicine and the Center on Gender Equity and Health at UC San Diego to include Dr. Stockman among our faculty,” she said.

Steffanie Strathdee, PhD, is Associate Dean of Global Health Sciences & Harold Simon Professor and Chief of the Division of Global Public Health and Director of the Global Health Initiative.

Gender-based violence is increasingly recognized as central to health and development globally, Strathdee said.

Dr. Stockman holds a PhD in Epidemiology with a focus on infectious diseases from the Johns Hopkins Bloomberg School of Public Health and a Master’s degree in public health from the George Washington University School of Public Health and Health Services. She is an alumna of the UC San Diego National Center of Leadership in Academic Medicine.

She currently holds a UC San Diego Clinical and Translational Research Institute Academic-Community Partnership Pilot Grant for her project, “The Role of Peer Navigators and Social Support in the HIV Care Continuum: Perceptions of HIV-Positive Women.”

For the Linda Saltzman New Investigator Award, the Centers for Disease Control’s National Center for Injury Prevention and Control solicits nominations from senior investigators in the field and convenes a committee of experts to select an outstanding individual to receive this national award once every two years.  Candidates for the award have 2-10 years of experience in their field.

Preventing Drug-Abuse-Related HIV in Tijuana by Educating Police

Dr. Steffanie Strathdee

Dr. Steffanie Strathdee

The NIH Record recently highlighted Dr. Steffanie Strathdee, Dr. Leo Beletsky, and their binational team for their efforts to prevent drug abuse-related HIV in Tijuana, Mexico, by changing the knowledge, attitudes and behaviors of the Tijuana police.

With support from the Open Society Institute and the UC San Diego Center for AIDS Research, the pilot phase of the project taught Tijuana police instructors how to prevent needle stick injuries by proper syringe handling, which advises them against breaking needles they apprehend from drug users. The training program is now being adopted by Tijuana’s police academy, whereby the police trainers will be teaching the program to their colleagues.

“We believe this program is the best way to reduce needle sharing among people who inject drugs, which is driven by policing practices,” Strathdee said.

The program will soon be tested in a newly funded grant by the National Institute on Drug Abuse, Proyecto ESCUDO (Project Shield): Harmonizing Law Enforcement and HIV Prevention through a Police Education Program.

Steffanie Strathdee, PhD, is Associate Dean of Global Health Sciences and Harold Simon Professor and Chief of the Division of Global Public Health and Director of the Global Health Initiative.

Strathdee co-leads Proyecto ESCUDO with Leo Beletsky, JD, MPH, adjunct assistant professor in the Division of Global Public Health at UC San Diego and assistant professor of law and health sciences at the Northeastern University School of Law.

HIV Transmission Networks Mapped to Reduce Infection Rate

Researchers at the University of California, San Diego School of Medicine have mapped the transmission network of human immunodeficiency virus (HIV) in San Diego. The mapping of HIV infections, which used genetic sequencing, allowed researchers to predictively model the likelihood of new HIV transmissions and identify persons at greatest risk for transmitting the virus. … Read the full story from the UC San Diego Newsroom