Walter H. Curioso

Access, use and perceptions regarding Internet, cell phones and PDAs as a means for health promotion for people living with HIV in Peru

BackgroundInternet tools, cell phones, and other information and communication technologies are being used by HIV-positive people on their own initiative. Little is known about the perceptions of HIV-positive people towards these technologies in Peru. The purpose of this paper is to report on perceptions towards use of information and communication technologies as a means to support antiretroviral medication adherence and HIV transmission risk reduction.MethodsWe conducted a qualitative study (in-depth interviews) among adult people living with HIV in two community-based clinics in Peru.Results31 HIV-positive individuals in Lima were interviewed (n = 28 men, 3 women). People living with HIV in Peru are using tools such as cell phones, and the Internet (via E-mail, chat, list-serves) to support their HIV care and to make social and sexual connections. In general, they have positive perceptions about using the Internet, cell phones and PDAs for HIV health promotion interventions.ConclusionHealth promotion interventions using information and communication technology tools among people living with HIV in resource-constrained settings may be acceptable and feasible, and can build on existing patterns of use.

Handheld computers for self-administered sensitive data collection: A comparative study in Peru

BackgroundLow-cost handheld computers (PDA) potentially represent an efficient tool for collecting sensitive data in surveys. The goal of this study is to evaluate the quality of sexual behavior data collected with handheld computers in comparison with paper-based questionnaires.MethodsA PDA-based program for data collection was developed using Open-Source tools. In two cross-sectional studies, we compared data concerning sexual behavior collected with paper forms to data collected with PDA-based forms in Ancon (Lima).ResultsThe first study enrolled 200 participants (18–29 years). General agreement between data collected with paper format and handheld computers was 86%. Categorical variables agreement was between 70.5% and 98.5% (Kappa: 0.43–0.86) while numeric variables agreement was between 57.1% and 79.8% (Spearman: 0.76–0.95). Agreement and correlation were higher in those who had completed at least high school than those with less education. The second study enrolled 198 participants. Rates of responses to sensitive questions were similar between both kinds of questionnaires. However, the number of inconsistencies (p = 0.0001) and missing values (p = 0.001) were significantly higher in paper questionnaires.ConclusionThis study showed the value of the use of handheld computers for collecting sensitive data, since a high level of agreement between paper and PDA responses was reached. In addition, a lower number of inconsistencies and missing values were found with the PDA-based system. This study has demonstrated that it is feasible to develop a low-cost application for handheld computers, and that PDAs are feasible alternatives for collecting field data in a developing country.

Characteristics and publication patterns of theses from a Peruvian medical school

BACKGROUND Many medical schools require a student thesis before graduation. Publishing results in a peer-reviewed journal could be an indicator of scientific value and acceptability by the scientific community. The publication pattern of theses published by medical students in Peru is unknown. The aim of this study was to assess the characteristics and publication pattern of theses in biomedical-indexed journals conducted by medical students in a university with the highest research output in Peru. METHODS Data from registered theses between 2000 and 2003 were obtained from the university library. Publication of theses in biomedical journals was assessed in 2008 by a search strategy using PubMed, Google Scholar, LILACS, LIPECS and SciELO. RESULTS Four hundred and eighty-two medical theses were registered between 2000 and 2003; 85 (17.6%) were published in biomedical-indexed journals. Of the published theses, 28 (5.8%) were published in MEDLINE-indexed journals, 55 (11.4%) in SciELO-indexed journals, 61 (12.6%) in LILACS-indexed journals and 68 (14.1%) in LIPECS-indexed journals. Most of the published theses (80%) were in Spanish and published in Peruvian journals; and 17 theses (20%) were published in foreign journals (all of them indexed in MEDLINE). In addition, 37 (43.5%) belong primarily to internal medicine, and 24 (28.2%) belong primarily to infectious diseases. Medical students were first authors in 71 (83.5%) of the articles. CONCLUSION In this study, most of the published theses were in Spanish, published in local journals and indexed in LIPECS. The percentage of published theses in biomedical journals at this university is comparable with others coming from developed countries.

Can the power of mobile phones be used to improve tuberculosis diagnosis in developing countries

The low-cost Microscopic Observation Drug Susceptibility (MODS) assay is a non-proprietary test that delivers rapid and accurate diagnosis of tuberculosis (TB) and multidrug-resistant TB. Although methodologically straightforward, implementation is challenging in isolated settings where personnel trained in plate reading are lacking. One affordable strategy to address this shortfall is the use of mobile phones, first to transmit images captured by an inverted microscope to a remote site where pattern recognition is performed by trained personnel, and second to receive the resulting output of this analysis. Such a system could be used for training of laboratory personnel through distance learning, resolution of equivocal appearances and quality assurance.

Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study

BackgroundAntiretroviral scale-up is increasing in resource-constrained settings. To date, few studies have explored the barriers and facilitators of adherence to ART in these settings. Facilitators and barriers of antiretroviral adherence in Peru are not completely understood.MethodsAt two clinics that serve a large number of HIV-positive individuals in Lima, Peru, 31 in-depth interviews were carried out in 2006 with adult HIV-positive individuals receiving ART. Purposive sampling was used to recruit the participants. Interviews were transcribed and coded using two Spanish-speaking researchers and a content analysis approach to identify themes in the data.ResultsAmong the participants, 28/31 (90%) were male, 25/31 (81%) were self-identified as mestizo, and 19/31 (61%) had an education above high school. The most frequently discussed barriers to adherence included side effects, simply forgetting, inconvenience, dietary requirements, being away from home, and fear of disclosure/stigma. The most frequently discussed facilitators to adherence included having a fixed routine, understanding the need for compliance, seeing positive results, treatment knowledge, and faith in treatment.ConclusionsOverall, these findings were similar to the facilitators and challenges experienced by individuals on ART in other resource constrained settings. Further treatment support tools and networks should be developed to decrease the challenges of ART adherence for HIV-positive individuals in Lima, Peru.

Opportunities for Providing Web-Based Interventions to Prevent Sexually Transmitted Infections in Peru

The popularity of Internet cafes in Peru, even in poor communities with no modern infrastructure, opens new possibilities to develop online prevention and intervention programs for sexually transmitted diseases.

Redes de colaboración y producción científica sudamericana en medicina clínica, ISI Current Contents 2000-2009

BACKGROUND International collaboration is increasingly used in biomedical research. AIM To describe the characteristics of scientific production in Latin America and the main international collaboration networks for the period 2000 to 2009. MATERIAL AND METHODS Search for papers generated in Latin American countries in the Clinical Medicine database of ISI Web of Knowledge v.4.10 - Current Contents Connect. The country of origin of the corresponding author was considered the producing country of the paper. International collaboration was analyzed calculating the number of countries that contributed to the generation of a particular paper. Collaboration networks were graphed to determine the centrality of each network. RESULTS Twelve Latin American countries participated in the production of 253,362 papers. The corresponding author was South American in 79% of these papers. Sixteen percent of papers were on clinical medicine and 36% of these were carried out in collaboration. Brazil had the highest production (22,442 papers) and the lower percentage of international collaboration (31%). North America accounts for 63% of collaborating countries. Only 8% of collaboration is between South American countries. Brazil has the highest tendency to collaborate with other South American countries. CONCLUSIONS Brazil is the South American country with the highest scientific production and indicators of centrality in South America. The most common collaboration networks are with North American countries.

Strategies for Aspiring Biomedical Researchers in Resource-Limited Environments

Countries struggling with global healthchallenges desperately need local biomed-ical researchers to find health care solu-tions to address the deadly diseases thataffect their populations. Building thescientific capacity of resource-limitedcountries is a clear priority among thescientific community [1–3].As the Global Forum for HealthResearch Report stated [4], ‘‘Strengthen-ing research capacity in developing coun-tries is one of the most effective andsustainable ways of advancing health anddevelopment in these countries and ofhelping correct the 10/90 gap in healthresearch.’’ The 10/90 gap refers to thestatistical finding of the Global Forum forHealth Research that only 10% of allglobal health research funding is directedto research on the health problems thataffect 90% of the world’s population [5].Great efforts are now being made tocorrect this gap, and some call it thegolden age of global health. Many re-searchers in resource-limited environ-ments have the opportunity to trainoutside their country and are offeredscholarships to do so, with the goal thatthey will return and help their country.For researchers willing to deal withdeveloping world challenges (poor infra-structure and support), there are excitingopportunities to solve a nation’s mostpressing health problems and make aname for themselves along the way.In this paper, we will share some keystrategies for aspiring biomedical research-ers based on the experiences of researchersaffiliated with Universidad Peruana Caye-tano Heredia (UPCH) in Lima, Peru—amajor hub for global health training inSouth America.

The role of medical students in the fight to control neglected tropical diseases: a view from Peru.

Neglected tropical diseases (NTDs) is a term that might not ring a bell among the majority of our fellow medical students. The World Health Organization (WHO) defines NTDs through a list of 15 diseases, all of them infectious, ancient, and debilitating [1]. Despite vast consensus on which are and which are not considered NTDs, the precise inclusion criteria are as hard to define as global health [2]. Nevertheless, we believe that three basic features that characterize NTDs are high burden of disease in certain specific contexts, neglected from prevention and control—including drug development, and long-term impairment among those suffering from them. Neglect is the central idea, because not only do these diseases sicken the historically neglected populations, but they also have long been neglected from the axis of research, innovation, and production. The objective of this essay is to describe and promote training opportunities on NTDs to medical students, especially in Peru and Latin America. We will describe two medical student organizations and how they are organized to address NTDs. Finally, we will suggest three methods—curriculum, research, and information dissemination—of raising awareness of NTDs among medical students in Peru. Defining the NTDs through globally applicable and locally sensible criteria, instead of a rigid pre-specified list, could eventually improve the struggle against them. In this effort, medical students should play an important role. The Peruvian National Institute of Health, by establishing long-neglected diseases specific to Peru—such as Carrion disease due to Bartonella bacilliformis [3] and hydatidosis [4]—as national public health priorities for research, has shown the imperative of the need for a local NTD agenda [5].

Ten years of international collaboration in biomedical informatics and beyond: the AMAUTA program in Peru

Well-trained people are urgently needed to tackle global health challenges through information and communication technologies. In this report, AMAUTA, a joint international collaborative training program between the Universidad Peruana Cayetano Heredia and the University of Washington, which has been training Peruvian health professionals in biomedical and health informatics since 1999, is described. Four short-term courses have been organized in Lima, offering training to more than 200 graduate-level students. Long-term training to masters or doctorate level has been undertaken by eight students at the University of Washington. A combination of short-term and long-term strategies was found to be effective for enhancing institutional research and training enterprise. The AMAUTA program promoted the development and institution of informatics research and training capacity in Peru, and has resulted in a group of trained people playing important roles at universities, non-government offices, and the Ministry of Health in Peru. At present, the hub is being extended into Latin American countries, promoting South-to-South collaborations.