Previously Completed Projects

Decentralization Course in India
Principal Investigator: Paul Campbell
Department: Global Health and Population & Health Policy and Management
Sponsor(s): Constella Futures International, LLC

Dr. Campbell, as well as other HSPH faculty members, has been holding international courses on “Decentralizing Health Systems” in Boston for a number of years and faculty have also been working in India on related issues. This project supported the development and provision of a course on decentralization offered during the week of July 30, 2007 in India. The purpose of this course was to deepen understanding of political and managerial decentralization internationally, and in India especially related to NRHM (National Rural Health Mission), and to develop written draft plans for implementing decentralization in the participating states. Dr. Thomas Bossert was co-director and taught many of the sessions and engaged Indian faculty as well.

Randomized trial of vitamin B12 in pregnant Indian women

Principal Investigator: Christopher Duggan
Department: Nutrition
Sponsor(s): NIH/NICHD

Dates of Research:
December 2008 — April 2014

The incidence of poor fetal growth and adverse maternal and infant birth outcomes is quite high in India, and several lines of evidence suggest that maternal nutritional status may be an important factor. In a prospective cohort study of 410 pregnant Indian women, these researchers recently found a strong relationship between maternal serum vitamin B12 concentration and the risk of infant intrauterine growth retardation. We have recently completed a randomized, double-blind trial among 300 pregnant Indian women in order to determine the effectiveness of vitamin B12 supplementation in improving child and maternal B12 status. Follow-up of these mother-infant dyads through 36 months post-partum is underway. See the study record detail.

Bangalore Boston Nutrition Collaborative
Principal Investigator: Christopher Duggan
Department: Nutrition

Emerging demographic, economic and dietary factors suggest that a large burden of preventable illness is poised to develop in India. In order to document these developments and to design feasible and valid public health interventions designed to reduce these health outcomes, a new generation of Indian nutrition scientists need to be trained. Since 2009, we have undertaken a collaborative educational effort with faculty at St. John’s Research Institute that includes: 1. An annual two week course in Nutrition Research Methods in Bangalore, co-taught by HSPH, Tufts and St. John’s faculty; 2. Distance learning with an interactive website; and 3. Student and faculty exchange visits for research collaboration. See Bangalore Boston Nutrition Collaborative.

See the January 2014 research article published by Biomed Central detailing the collaborative.

Dose Response Modeling in Epidemiologic Cohort Studies 
Principal Investigator: Ellen Eisen
Department: Environmental Health
Sponsor(s): NIH/NCI

This proposal builds on current work applying semiparametric statistical methods to model nonlinear exposure-response curves with smooth functions of exposure in occupational cohort studies (R01CA81345). In the course of adapting penalized splines for survival analysis, there have been two issues identified that need further development: 1) criteria for choosing the optimal amount of smoothness; and 2) diagnostic statistics to identify influential observations and measure their influence on the fitted values of the curve. These issues are examined in the presence of the right skewed distributions typical of workplace exposures. Comparisons are made of the goodness of fit and resistance of penalized splines to that of two other common smoothers: restricted cubic spines, and a locally weighted regression smoother called “loess.” They will re-analyze two cancer mortality studies: larynx, lung, prostate and rectal cancer in autoworkers exposed to metalworking fluids (MWF) and lung cancer in California’s diatomaceous earth industry exposed to crystalline silica.

Global Maternal Morbidity and Mortality Policy Model
Principal Investigator: Susanne Goldie
Sponsor(s): John D. and Catherine T. MacArthur Foundation

This project focused on the development and refinement of a Global Maternal Morbidity and Mortality Policy Model. The project adapted this model to permit evaluation of strategies for the reduction of maternal death and disability in India. Specific activities included: modification of the natural history to reflect the epidemiologic pattern of maternal health in India, and modification of the intervention module to reflect India-specific utilization patterns of interventions and intervention effectiveness; expansion of the model to allow for Monte Carlo simulation to evaluate targeted strategies (i.e., increased risk for complications due to age and parity); and increasing the model’s capacity to consider additional health and economic measures of maternal morbidity or co-morbidity. Using the model, our analyses will focused primarily on maternal outcomes but secondary analyses were expected to encompass the broader societal viewpoint, such as the positive effects of maternal health interventions on neonatal health, survival, and the welfare of the family.

Optimizing HIV Care in Less Developed Countries
Principal Investigator: Susanne Goldie
Department: Health Policy & Management Center for Health Decision Science
Sponsor: Massachusetts General Hospital

Advances in the treatment of HIV disease have produced dramatic reductions in AIDS-related morbidity and mortality in the United States and Europe. However, because of severe resource constraints in Africa, Asia and less developed countries throughout the world, neither prevention of opportunistic infections nor HAART have been widely available. This project utilizes the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model to focus efforts in three less developed countries, with the following specific aims: 1) to develop a comprehensive state-transition model of the natural history and treatment of HIV disease in less developed countries; 2) to analyze data on HIV natural history, treatment efficacy, treatment cost, and quality of life in Ivory Coast, India, and South Africa; and 3) to utilize the model with country-specific data to determine the clinical impact, cost, and cost-effectiveness of different strategies for opportunistic infection prophylaxis, tuberculosis preventive therapy, and antiretroviral use in each of these countries, and to disseminate these analyses to help inform and develop country specific guidelines for HIV care.