making a right turn2!

8/12/2019 Making a Right Turn2!

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Keeping the Passion

Alive Making the Right

Turn

Geraldine Padilla, PhD

Professor and Associate Dean

UCSF School of Nursing


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Signs of Need for Change

Decrease in research interest, creativity,

energy

Interest in finding something new

Hopping around from one scientific

area to another

Feeling a knowledge deficit


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Value of Change

Renewed energy and sense of

discovery

New challenges

New collaborators

Study in foreign land, culture, language

New funding sources, regulations


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NIH Support for Change

NRSA for Senior Fellows (F33):

NIH awards F33s to experienced

scientists who wish to make major

changes in the direction of their

research careers or who wish to

broaden their scientific background by

acquiring new research capabilities.

(Supported by NINR and many other Institutes)


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NIH Support for Change

Career Enhancement Award (K18):

Provides full/part-time support for

experienced scientists who wish to

broaden their scientific capabilities or

to make changes in their research

careers by acquiring new research skills

or knowledge. Award usually no more

than 1-2 years. (Not supported by NINR and

others. Stem cell research supported by some Institutes)


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Other Support for Change

Fulbright (Full Grant):

These grants provide some funding for

research, books, supplies, in country

travel, living allowance.

Good and feasible study plan

Strong host country support for the

project


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Institutional Support for Change

Sabbatical, Mentor, Training

Research Intensive Universities: OK if

fundable and publishable

Education intensive Universities: OK if

content/clinical expertise and teaching

continue in assigned areas


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Personal Plan

Used sabbatical

Obtained in country support from the

Philippine Cancer Society

Collaborated with the Calif Div and

Natl American Cancer Societies

Obtained Fulbright Award for 4

months


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Hepatitis B and Filipino Infants

PROBLEM: HBV Prevalence in Filipinos

1986 estimates: 12 of Filipinos (about 5

million) infected with HBV (

Lingao et al. Am J Epi

1986;123:473-480)

2004 estimates: 8 10 of Filipinos

(about 8 million) infected with HBV

(Philippine Cancer Society, 2004)

2008 estimates to be published by PCS


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Prevalence of Chronic Hepatitis B

High: 8% & above Intermediate: 2-8% Low: Below 2%


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Purposes:

Describe status of Philippine policy

implementation on HBV inoculation of

newborns

Explore strategies to guide policy

implementation

Work with the Philippine Cancer Society

on plans to promote implementation


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HEPATITIS B DISEASE

Inflammatory liver condition caused by

hepatitis B virus (HBV) infection

Persons with HBV may recover and

develop lifelong immunity from the virus

or they may become chronically infected


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HEPATITIS B DISEASE

Acute Hepatitis B

duration: several weeks

symptoms: poor appetite, weakness, nausea,

vomiting, abdominal or joint pain, jaundice, dark

urine, skin rashes

Chronic Hepatitis B

duration: lifetime

symptoms: 30 no signs of illness mortality: 15-25 die early of HBV-related

diseases, e.g. liver cancer, cirrhosis

WHO 2001, So 2005, WHO 2003


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HBV: Chronic infection

Mother to infant transmission accounts

for 1/3 of HBsAg positive infants at 1

year (Lingao et al., 1989)

15-25 of chronically infected die of

HBV-related diseases (WHO, 2003)


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Philippine DOH

(Central) Manila

DOH CHD-

Region V

(6 Provinces)

ProvincialHealth

Office

City/Municipal

Health Office

District Health

Office

Barangay Health

Center

District / Provincial

Hospitals


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US COMPREHENSIVE IMMUNIZATION STRATEGY

ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)


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HB Vaccination Schedule for Newborns: Philippine

DoH Policy (2006)

First dose at birth*

Second dose at 6 weeks**

Third dose at 14 weeks**

*If mother HBsAg or HBeAg positive, 1

st

dose given

ASAP after birth + HB immune globulin if available

and/or affordable

**2

nd

, 3

rd

doses timed with other immunizations to

promote adherence to follow-ups


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HB Vaccine as part of Expanded Program on

Immunization: Philippine DoH Policy (2006)

PDoH supplies free HB vaccine for

children 0-11 mo. through public health

facilities nationwide

2007 75 of HB vaccine needs2008 100 of HB vaccine needs


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METHODOLOGY:

Design & Subjects

Pilot, descriptive study

Face-to-face recorded interviews

32 stakeholders, but N=30 health care

providers

> 21 years, Speak English/Tagalog

Involved in implementing the HBV

infant vaccination program


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HBV Immunization Study: Interview

Content

Knowledge of HBV infant vaccination

policy

Role in policy implementation

Perceived barriers, facilitators, strategies

related to policy implementation


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Procedures with participants

Signed a consent form

Participated in a 30 min - one hr interview

Interviews audio recorded, transcribed, all

names erased, recordings destroyed after

transcription

Interviewed in work place or a convenient

location

Received P500 (pesos)


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Health Care Providers

30 interviewed from 1/18-4/15/07, 1/09

21 females, 9 males

29 govt 1 NGO

12 MDs, 15 RNs, 1 Midwife, 2 Barangay

Health Workers

14 Admin/EPI Coordin, 1 Med Train, 12

Clinicians, 2 BHWs, 1 NGO volunteer

l


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HBV Immunization Study: 23 locations

15 urban, 4 semi-urban, 4 rural

13 metro Manila, 1 Marikina

Provinces: 6 Sorsogon, 1 Ilocos Sur,

1 Masbate, 1 Batangas


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HBV Immunization Study: Results

Impact of PDoH decentralization

PDoH supplies the vaccine

Local governments budget support of

public health clinics which implement HBV

immunization policy

Financial support uneven across 23

locations


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HBV Immunization Study: Results, 23 locations

Written policy

on hand

2 Rural

2 Semi-rural

6 Urban

No written policy

on hand

2 Rural

2 Semi-rural

7 Urban

2 NA


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Cold storage charts/records on hand

5 out of 7 clinics

2 out of 5 hospitals

5 out of 7 city/provincial health offices

1 Health office, 1 clinic, 1 NGO, 1 Business -

not applicable


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Vaccination charts/records available

5 out of 8 clinics

1 out of 5 hospitals

3 out of 7 health offices

1 Health office, 1 NGO, 1 Business - not

applicable


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Hepatitis B & Filipino Infants: Results

21 applicable locations

Factors facilitating policy implementation - but

not consistently

Monovalent HB vaccine 10-dose vials available

Training programs for health care providers available

HB immunization patient handouts and brochures

available at clinics and hospitals

Health care locations promoted 2

nd

, 3

rd

dose follow-

ups with tracking through immunization cards &

designated personnel


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21 applicable locations

Barriers to policy implementation

Problems with vaccine and syringe distribution

Inadequate clinic budgets for appropriate personnel

Lack of money and distances to clinic for follow-up

doses

Issues with refrigeration capacity and cold storage

maintenance in emergency situations or for

transport in rural areas


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30 Health Care Providers

Knowledge about vaccine integrity: All

30

Knowledge about Hep B infant

inoculation policy: Knowledge deficit

among some health professionals


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Type of inoculation schedule

implemented

22 followed new schedule (birth, 6, 14

weeks)

4 followed old/other schedule (6, 10,

14 weeks, or other)

4 followed both


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Personal knowledge of vaccine

availability policy

27 knowledgeable

3 ignorant


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Knowledge & attitudes concerning

vaccine policy

29 reported no negative cultural biases

among mothers toward infant

immunizations

but moderate to poor client knowledge

of the inoculation schedule or

appreciation of its importance


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HBV Transmission Modes

Transmission occurs when infected blood

enters the body of a person not infected

Infected mother to child at birth

Wound to wound contact

Sharing toothbrushes, razors

Reusing needles (medical or nonmedical)

Unprotected sex with infected person


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HBV Transmission Myths shared by

Filipinos

Sharing food or water

Sharing eating utensils, drinking water

Casual contact

Hugging or kissing Breast feeding


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Hepatitis B & Filipino Infants:

Preliminary Conclusions

Some progress made to reach 100 HBV

inoculation of newborns

Exact information on number of newborns

receiving 1

st

, 2

nd

and 3

rd

doses unknown

Insufficient data to determine rural versus

urban differences in policy knowledge or

implementation


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Research Needed

Identify gaps in knowledge and

implementation of HBV vaccination policy

& procedures country-wide

Identify strategies/technologies to promote

efficient distribution & storage of supplies

Describe gap between births recorded and

inoculations received across Barangays, in

rural versus urban areas


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Research Needed

Improve knowledge of & adherence

to HBV infant inoculation policy

among health care providers

Identify strategies to assist mothers to

adhere to inoculation schedule


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Research Needed

Evaluate impact of Train-the-Trainer strategy

implemented by the Philippine Cancer

Society at Provincial or District Health level

on:

Knowledge of Barangay Health Workers

Knowledge of mothers

Inoculation of infants


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Hepatitis B and Filipino Infants:

Did I Make the Right Turn?

Pilot data presented at research conference

Pilot data needs to lead to future funded

study at R01 level, but first need further

baseline data on number of infants

inoculated to determine need

Have maintained great interest in the area

Feel hopeful about impact of research

Funding interest in Infectious Dis. Is Africa


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Acknowledgements

US Fulbright Scholar Program

PAEF

Philippine & American

Cancer Societies

Myrah Lelis

All Project Participants

Magka-isa Laban sa HBV Ang Jade Ribbon


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Magka isa Laban sa HBV.Ang Jade Ribbon

ay tiniklop na parang Chinese karakter para sa

lahat na simbolo sa pagkakaisang tinig ng

mamamayan laban sa Hepatitis B at kanser saatay sa buong mundo.

Para sa karagdagan na impormasiyon, bisitahin

ang http://liver.stanford.eduAsian Liver Center
http://liver.stanford.edu/http://liver.stanford.edu/


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Thank You


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making a right turn2!

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