Current and Completed Research Projects

A main strength of the HPN is that it provides a single platform for addressing many of the major respiratory conditions that affect people in the world’s poorest communities.  Most global health interventions address only one disease or condition.  The HPN is a device that can be used to diagnose TB, treat asthma and COPD, and, we anticipate, treat LRIs and possibly deliver vaccines.  The HPN — this one device — will exponentially enhance the capabilities of rural clinics and community health workers to provide effective treatment to underserved patients.  Our current research projects have two foci.  First, we seek to validate the clinical equivalence of the HPN to electric nebulizers for this variety of diagnosis and treatment applications.  As importantly, we are exploring the cultural and intra-professional dynamics surrounding the deployment of the HPN, particularly with regard to community health workers.

 

Cost-Effectiveness and Field Testing of the HPN in Guatemala

Promotore Graduation TecpanIn 2016, the HPN team will travel to Tecpan, Guatemala, to launch its second field study.  Working with Asociacion Vida, an NGO sponsored by Willowcreek Church, we will equip 20 community health workers with HPNs who will use them under the oversight of a local physician.  Unlike the more highly developed medical infrastructure in El Salvador, we hypothesize that the structure of health care delivery in Tecpan more closely approximates the conditions where we anticipate the HPN will ordinarily be used.  This study is funded in part by the monies raised through our 2015 Indigogo campaign.  This will be the first time the HPN Project has traveled to Guatemala.  We are looking forward to our collaboration with Asociacion Vida.

 

 

Cost-Effectiveness and Field Testing of the HPN in El Salvador

In summer 2015, the HPN Project completed its first field study of the device in El Salvador, examining the cost-effectiveness of the HPN in the contexts for which it was designed.  In conjunction with the Ministry of Health of El Salvador, 14 HPNs were given to community health workers, or promotorés, who are part of Ministry of Health teams called ECOS Familiares.  (ECOS stands for Equipos Communitarios de Salud).  Each ECOS team consists of a physician, nurses, promotorés, and others who rotate through underserved areas and attend to the health needs of that population.  This deployment studied three questions.  First, we sought to assess the effectiveness of a training program for these community health workers.  Second, we collected data on how often the HPN was used and for which conditions.  We documented the number of patients treated and will analyze these figures relative to places where the HPN was not deployed to assess whether HPN availability had an effect of reducing patient loads in regional clinics.  This piece of the study is examining not only whether the HPN expands access to treatment but also questions of cost-effectiveness.  We hypothesize that treatment with the HPN in rural areas will decrease patient load in overburdened clinics and offset the cost of inhalers which are expensive in rural regions.  Finally, this deployment tested the HPN in places similar to where it will be widely used.  Data from this study are currently being analyzed.
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Treatment of Adult Asthma in El Salvador

In 2010, the Salvadoran Minister of Health, Dr. María Isabel Rodríguez, invited the HPN team to conduct a clinical trial in collaboration with the Ministry of Health to compare the effectiveness of the HPN with that of an electric nebulizer in the treatment of mild to moderate asthma in adults and children. Partnering with the Universidad Salvadoreno Alberto MasFerrar (USAM), the study began in August 2012 and was completed in October. This was the first clinical trial of the HPN as a therapeutic device.  It provides the clinical foundation for deploying the HPN in remote communities for treating COPD — one of the leading causes of morbidity and mortality in the developing world.  It also enables the HPN to be used to treat children with asthma, a dire need in developing contexts.  The results of this study have been published in npj Primary Care Respiratory Medicine (2014).

 

TB Diagnosis in South Africa

The first clinical study of the HPN examined its effectiveness in assisting with TB diagnosis.  Improved diagnosis means more aggressive screening in populations where TB is rampant.  This involves obtaining a sputum sample which may be hard to do for people who are not very symptomatic.  Nebulizers are currently used to induce a sputum sample in these individuals. In collaboration with Dr. Katarina Kranzer of the London School of Hygiene and Tropical Medicine, the Desmond Tutu HIV Centre in Cape Town and colleagues at Northwestern University, the HPN was shown (in summer 2010) to be equivalent to an electric nebulizer in the quality of sputum sample produced in individuals in rural townships surrounding Cape Town, South Africa.  For the published results of this study, click here.

We are currently seeking funding for a larger study to confirm the effectiveness of the HPN for TB diagnosis.  Our study in Cape Town demonstrated the efficacy of the HPN for producing sputum samples for TB diagnosis. We now wish to validate, with a larger participant pool, that the HPN is equally effective as an electric nebulizer in TB diagnosis itself.

 

Community Health Workers in El Salvador

With the support of the NCIIA, we have begun exploring the various cultural and inter-professional dynamics surrounding the deployment of the HPN in different contexts.  In summer 2010, we interviewed community health workers, community members, and health professionals throughout El Salvador to evaluate perceptions about the prospect of community health workers being the focus in fighting respiratory diseases with the HPN.  The outcomes of those interviews was very encouraging, both in terms of enthusiasm about the need for the HPN and regarding the appropriateness of community health workers overseeing a technical, therapeutic device.  We anticipate that different cultural contexts will present different responses to our questions;  a key part of the HPN Project, therefore, will be continued research on cultural dynamics surrounding community health workers.  This research will enable us to work more effectively with Ministries of Health and NGOs to develop HPN specific training programs for community health workers.

Future research will target the many other potential applications for the HPN.  These include administering nebulized vaccines, treating chronic obstructive pulmonary disease (COPD), treating lower respiratory infections, treating asthma in children, and treating TB via nebulized antibiotics.