STEP Project Reflection: Acute HIV Research in Lilongwe, Malawi

This summer, I spent ten weeks in Malawi, a small country in southeast Africa, completing my STEP Signature Project. In Malawi, I worked on an epidemiological study through the University of North Carolina’s Project Malawi. The study, called iKnow, focused on acute HIV sexual partner and social contact referral with goals to determine the most effective ways to identify, test, and treat the HIV-infected population of Malawi and other regions like it. Through these efforts, the study works to advance Malawi towards the UNAIDS’ 90-90-90 initiative, a treatment target by which 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression.

I served as the project intern for this study with main responsibilities of managing and cleaning study datasets, completing needs assessments to determine sustainable ways to improve study efficiency, facilitating team training sessions to implement these efficiency initiatives, and updating study protocol documents. I spent a large amount of time shadowing nurses, gynecologists, pediatric nephrologists and pediatric cardiologists allowing me to compare standards of care in Malawi to those in the United States. I also spent a large amount of time shadowing various epidemiologists to observe study development, implementation science, and other research methods in practice.

This summer was my first time out of North America. I was hesitant for my first experience abroad to be such a long trip to a third-world country. At times I thought about pursuing an informal vacation abroad before an academic experience abroad. Despite any formal orientation to the type of environment and culture I would soon become immersed in, I successfully completed this experience. This showed me that I can challenge myself and thrive in conditions foreign to me.

This experience furthered my ability to relate to people of different backgrounds. An example of this occurred within my first few weeks in Malawi. I was under the impression that being placed in an established intern position would mean that my help would be immediately accepted in the clinic. However, I found that I had to prove myself as a person, friend, and co-worker before gaining the clinic staff’s trust. As I gained their trust and friendships I also gained responsibilities.

Photo: Me and the iKnow study staff at the clinic in Lilongwe, Malawi

In addition to the clinic staff, I made lasting connections with visiting accomplished researchers and physicians, and graduate students in medicine, pharmacy, dentistry, and public health. I was able to learn about their interests and career paths and apply their experiences to my life. I am still in contact with some of these students, researchers, and physicians – both American and Malawian – who have become mentors and friends to me.

Before participating in this experience, I was fairly certain that I wanted to pursue medical school after graduation but was unsure how much research I wanted to incorporate into my studies and career. After completing this experience, I have additional confidence in a career in medicine and infectious disease epidemiology. I have determined that I really enjoy the research process and I am now considering working towards an MD-PhD in Epidemiology. Having an MD-PhD will give me medical and research methods skills that would allow me to lead projects, similar to the one I worked on this summer, that focus on infectious disease epidemiology both locally and in developing countries.

Despite hesitations, fears, and culture-shock, this experience was the best way I could have used my STEP funds, as it transformed me personally and professionally. It transformed how I view the people, governments, infrastructure, and medical systems in the United States and third-world countries like Malawi. It transformed my educational path to one, that while much longer, will be that much more fulfilling.