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Here’s a physician on quest to examine liver fibrosis among HIV patients

Dr. Wekesa envisions that her study will bring to light liver disease as a significant NCD in the region and also highlight the role non-communicable risk factors in its causation, most of which are modifiable and for which preventable measures can be fashioned and or strengthened.

Dr. Clara Wekesa’s background in research and medical work exposed her to these two areas in a very complementing way. It was almost natural for her to develop a career in medical research. The more mentorship she received, the more motivation she developed to pursue a career in research.

Today, she is a THRiVE PhD scholar based at the Infectious Disease Institute. Her PhD research aims to examine liver fibrosis among individuals with HIV infection in Kampala. Fibrosis, the formation of an abnormally large amount of scar tissue in the liver, is an indication of liver disease and it compromises the function of the liver.

With ever increasing access and use of anti-retroviral therapy (ART), persons with HIV/AIDS are increasingly prone to non-HIV related morbidity and mortality, such as liver disease. Results from a 2011 study conducted in Rakai district indicates that prevalence of fibrosis was 17% among HIV-infected and 11% in HIV-uninfected participants. It was discovered that HIV infection was associated with a 50% increase in liver fibrosis among HIV patients.

As a way of building onto the rural study in Rakai, Dr. Wekesa’s research focuses on the evaluation of liver fibrosis using Fibroscan technology among HIV-infected persons attending an urban clinic in Kampala. Fibroscan technology works like an ultra-sound scan to ascertain presence of liver fibrosis or the absence thereof.

“My research sets out to examine how much fibrosis is among HIV patients and what risk factors drive this burden e.g. alcohol and tobacco use, aflatoxin exposure and other non-communicable conditions such as abnormal sugar and fat metabolism,” she said in an interview.

One of the research objectives is to evaluate for other blood based screening indices for liver fibrosis that are widely accessible and cheap in order to facilitate timely referral of those identified with liver fibrosis with the hope that disease progression can be halted.

Dr. Wekesa envisions that her study will bring to light liver disease as a significant NCD in the region and also highlight the role non-communicable risk factors in its causation, most of which are modifiable and for which preventable measures can be fashioned and or strengthened.

The only limitation to her desire is the fact that fibroscan technology is only limited to research settings owing to the costliness of the equipment, but just like the Gene Xpert technology for TB, she is hopeful that it shall soon be widely available.

Road to Excellence
Dr. Wekesa was fortunate to find a mentor in every step of her career who offered guidance and support. After her bachelor’s degree she found a mentor in Dr. Fred Semitala when she joined the Makerere University Joint Aids Program (MJAP). She benefited from his advice and solidified her interest in building a science career. Thereafter, she returned to Makerere University to pursue her Master’s Degree in Internal Medicine. For her thesis she received further mentorship from her supervisors and mentors Prof. Moses Kamya, one of the founders of the Infectious Diseases Institute, Dr. Achilles Katamba, a seasoned researcher and Epidemiologist attached to the College of Health Sciences Makerere University and Dr. Bruce Kirenga, Head of the Uganda Lung Institute. Furthermore, she also looked up to women who had excelled in the science career.

“When I saw many women in science who had excelled and climbed up the academic ladder such as Prof. Mayanja, Prof. Pauline Byakiika and Prof Nakanjako I believed I could also make it,” she said.

After her master’s degree, Dr. Wekesa joined the Medical Research Council (MRC/UVRI) where she oversaw a number of projects, involved in the day to day running and offering support supervision. Owing to the fact that she was in charge of several studies related to hepatitis, she picked interest in studying liver diseases.

She went on to write a grant and was awarded the Trust in Science Africa Grant with GlaxoSmithKline (GSK) to study liver fibrosis among HIV patients in rural Uganda, particularly, Kyamulibwa in Kalungu district. In 2015, Wekesa moved to Mengo in Kampala and here she was in charge of overseeing a diabetes project run by MRC/UVRI. This project was part of a multi-site study being conducted in six other African countries. It is after the completion of this study that Dr. Wekesa made a decision to apply for the THRiVE PhD opportunity.

Although she had a three weeks’ baby, THRiVE afforded her the flexibility to do interviews and was awarded the fellowship. Dr. Wekesa’s PhD research is an extension of the study that on liver fibrosis that she conducted in Kyamulibwa. She is studying the same phenomenon among HIV patients in urban areas and comparing her observations with a non-HIV infected population

Word to the wise
If she was to give advice to her younger self, she would tell her to regard mentorship as an important element in life. This is because after completing school, there are many pending decisions to make such as: furthering a career and starting a family, for each one needs to be guided well.

And as she is garnering more milestones up her sleeve, her advice to early-career scientists is:
‘It is important to be patient, keep focused and follow through with something that you are passionate about.’

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