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Communities with limited wealth suffer of diseases in a way that many of us may never come to be confronted with. Poverty befriends disease, and many diseases befriend shame.
Nitika Pant Tai knows this well and is dedicated to do something about it. She was one of the finalists of the ASAP awards for developing a phone app that will lower the barriers for HIV testing by removing the shame that usually comes with going to a clinic for the test. The phone app will help people do the test at home and connect with the right people and information.
I asked Nitika a few questions, and this is what she had to say:
Q: How did you come to be involved in this line of work? Was there a trigger at some point that made you place your attention onto this line of work specifically, or was this just serendipity?
NPT: I am a trained medical doctor with a doctorate in research methods- and a masters in public health- my broad training helps understand all sides of the health spectrum. I realized early on in my career that treating patients can only go so far, and that my calling lay in treating and improving health systems- it didn’t happen like it happened for Gautama Buddha –under a tree– but certainly a lot of soul searching and introspection—deep introspection of your calling in life. And it happened at this magically transformational place called Berkeley, California.
How did you end up in such an offbeat, unconventional and unusual career?
US offered me so many choices and wonderful people who served as great role models—so choices created confusion, but meditation helped zone in. This realization of my calling was fuelled and solidified when I enrolled into an MPH program at the University of California at Berkeley- It took me on a tangential track of academic research, a PHD in Epidemiology and Biostatistics and a deep interest in understanding the HIV epidemic –followed by a fellowship in infectious diseases and trials at McGill University, Canada. Several role models at Berkeley and San Francisco, Dr Jackie Tulsky, the late Warren Winkelstein, Art Reingold, Jack Colford, Ira Tager were all physicians who changed their career tracks to public health and research inspired me. They supported me in plunging into my calling in life. My husband, Dr Madhukar Pai was my constant support and role model and he encouraged and supported this radical shift from clinical surgery to public health.
After stepping out of my physician’s coat and all that comes with it—I began to listen to people– to patients, to front line health care workers, to staff. By listening to their woes, I realized I could help them by being their advocate. It wasn’t about what I wanted to prescribe them; it was about what they wanted to prescribe me for their betterment. That was a paradigm shift. It did teach me humility. I was way too arrogant before. I thought I fixed the clinical problem and that did it, sadly, it didn’t.
I continued with the line of research, when, I started out as a graduate student. I appreciated research and now I teach clinical research methods to residents at McGill University and try to inspire them to think more…
What do you like about your work?
The big picture issues of developing strategies for dysfunctional health systems that impacted several lives appeared more challenging and impactful to me, and fascinated me—I knew I could come up with solutions… Having seen them in close quarters in India. After trying to understand US, Canadian and South African health systems, the functionalities, the ecosystem, and the dysfunctionality, (both the yin and the yang) I thought harder about what I could do through implementation research and now, innovation.
I love working with people from all different backgrounds and I have a deep passion for the field of medicine and public health and love to solve these big problems that are complex, dysfunctional, complicated . I synergized all three. Thankfully, my research got funded by Canadian Institutes for Health Research, and by the Gates Foundation. And innovations and challenging out of the box approaches got funded by Grand Challenges Canada, so these propelled me in the right direction. I conducted experiments in different settings: India, US, Canada,- South Africa. Each country presented its problems and its health systems. but—the a common denominator that we create solutions for is a human life!
My current project is a natural extension of my decade long independent work on oral fluid diagnostics for HIV. I evaluated the accuracy of this test in tough rural settings in India. I developed an innovative strategy with oral self tests for women in labor, performed a meta-analyses on accuracy of these tests for self testing then moved on to evaluating self testing strategies. Armed by solid evidence, and training in methods and clinical disciplines, I designed strategies. One thing led to another. And then Grand challenges Canada happened. It sparked the innovator geek in me. I wanted to do something different, and with GCC funding and support for out of box approaches, I pursued it. Solidified by evidence that I collected myself—after having convinced myself—I went ahead with that conviction.
I listen to no one but myself—very stubborn– you would say. Even if I am in the wrong—I learn by making my own mistakes. My parents have always let me be-a philosophy that I carry on with my students, trainees and my own child. And I believe in old world values of universal good and cross cutting solutions that impact all people across the world. I believe in Karma and destiny. I am a visionary and a right brain dominant physician scientist, I imagine solutions of the future. I also love painting and cooking and writing poetry, my right brain balances my analytical left brain.
Q. Can you tell me a bit more about the app?
NPT: I won the award for the HIV self -screening strategy and innovations developed for it. The app is part of that . The App is copyright protected and so we haven’t publicly released it yet.
It is an Android Google application (globally portable) that guides anyone who wishes to self test through the process of self-testing. Teaches them on what they need to know information on HIV, walks them through self test process (conduct and interpretation) and linkages to clinics and counseling can also be operationalized with it. It works with an oral HIV self-test. Currently in English but will be translated into several languages and platforms.
Q: How closely have you been working with the target group for which you developed the app? What has their response or involvement been in the project?
NPT: For the past 12 years, I have conducted clinical research in HIV in marginalized populations worldwide (i.e., incarcerated populations in USA, STD clinic attendees and pregnant women in India, IDU’s and immigrants in Canada). I have also led and completed research projects in students and health care workers in Montreal and South Africa. So, I have been in touch with the needs of various populations in different contexts and settings.
To develop the application, we first started out with a paper application that we evaluated in different populations –formally as part of clinical studies and informally by introducing it to different groups- counselors, patients, providers for feedback. Then, we were funded by Grand Challenges Canada to conduct a study in South Africa. So we further refined our application- created an Internet application and tested content formally in a study in health care professionals. After doing that successfully, we converted it to a smartphone application and tested that for design, user interface, usability features. We are now trying to customize the application for various countries ( i.e., India, South Africa, Canada, to name a few)
I was thinking of s global self-tester when I thought of an app. I sought feedback from the HIV community – from patients, from my colleagues (HIV clinicians), from public health professionals, and from people (that included members of my family-who are not into medicine, but familiar with apps). We showcased a first prototype at the London Self testing group, followed by GCC conference in Ottawa, and most recently at the International Aids Conference, in Kuala Lumpur. After a positive feedback , we decided to customize it for different settings and cultures for wider global applicability.
Q: How widely do you see this approach being adopted?
NPT: After showcasing it, I was convinced that there is a niche for it. I received requests from various groups (research groups, foundations, industry, and public health agencies) so I do foresee it helping many people and I think it will be adopted by the digital savvy people. We have different applications for different audiences.
Q: Going through your website, I found out that your focus is not just on HIV. What is it about those diseases that attracted your attention?
NPT: I have been involved in diagnostic research with point of care technologies for HIV and related co-infections (i.e., Hepatitis C, Hepatitis B, syphilis, TB) for about a decade now. I have focused on diagnostics and treatment issues around HIV. I had led Implementation research in both developed and developing settings.
Related diseases have attracted my attention, because often times, we fail to do a good job of diagnosing, treating or controlling HIV alone and people die from others (Hepatitis C, TB). I have a passion for solutions to improve Women’s Health ( developing countries) and I am working extensively on that now.
Q: Do you think there is a potential to build similar apps for a broader range of diseases?
NPT: Of course! There is always an app to fill a gap! I have several now in my mind…wont spill the beans today 🙂