Aiding the most vulnerable

Bill Snyder
Published: July, 2006

In 2006 Vikrant Sahasrabuddhe, M.D., MPH, DrPH, returned to Pune, the city of his birth, to help some of the most vulnerable members of Indian society—HIV-infected women.

Ward for women patients in Sassoon General Hospital, Pune, India.
Courtesy of Vikrant Sahasrabuddhe
In collaboration with the National AIDS Research Institute in Pune, Sahasrabuddhe, a research assistant professor of Pediatrics at Vanderbilt, is testing a visual inspection method for diagnosing cervical cancer, the leading cause of cancer deaths among Indian women.

The risk of cancer is particularly high among women who are infected with HIV.

In the United States, the Pap smear is credited with reducing the cervical cancer death rate by 70 percent since it was introduced in the early 1940s.

In resource-poor countries like India, however, collecting smears of cervical cells, sending them to the lab for analysis, then reporting the results is “a recipe for failure at multiple stages,” Sahasrabuddhe says. “Most women do not even get a once-in-a-lifetime Pap smear exam.”

An alternative is visual inspection with acetic acid (VIA), a one-step clinical test that can be performed by a nurse and which may be as accurate as the Pap smear. The cervix is viewed through a speculum after application of acetic acid. “If the cervix turns white, it’s an indicator of a precancerous lesion,” he says.

While earning his doctorate in Public Health at the University of Alabama at Birmingham (UAB), Sahasrabuddhe participated in a pilot study of VIA in HIV-infected women in Zambia directed by Sten Vermund, M.D., Ph.D.

Based on encouraging early results, the study is being expanded to all of the public health clinics in Lusaka, the Zambian capitol, and to Pune, a city of 3.5 million people southwest of Mumbai (formerly Bombay). “It’s right on the Mumbai-Chennai highway, which is a hotbed of HIV transmission with the south of India,” Sahasrabuddhe says.

Vermund, who joined the Vanderbilt faculty in 2005, is the study’s principal investigator, and Sanjay Mehendale, M.D., MPH, senior deputy director of the National AIDS Research Institute, is the principal collaborator in Pune.

Other partners include UAB and John Hopkins University Bloomberg School of Public Health, which sponsored Sahasrabuddhe’s doctoral studies at UAB. In addition, a Vanderbilt medical student and two undergraduates will contribute to the research this summer.

“The diversity of the human population in India is going to open a lot of doors for people who are interested in medicine and health,” Sahasrabuddhe explains. The study also provides insight into the problem of health care disparities, no matter where in the world they occur.

“We’re looking at socioeconomic barriers, human factors, institutional or systemic factors which prevent access to screening,” he says. Interventions that don’t account for these factors “are bound to fail.”

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