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Seble Kassaye, MD, MS

Dr. Kassaye's career has been driven by her clinical experiences taking care of HIV-positive patients.  Her research interests in clinical and translational HIV research is primarily derived from a strong interest in increasing access to effective HIV prevention and treatment strategies to the most at risk and indigent populations. This is exemplified in her research on HIV treatment access and service delivery models in sub-Saharan Africa prior to the scale up of HIV treatment through PEPFAR; her interest in lower cost diagnostics including viral testing for HIV quantitation and drug resistance; perinatal HIV transmission prevention; and more recently in the molecular epidemiology of HIV in DC. The translational research she has participated in ranges from laboratory medicine including assay development, drug resistance testing, and point of care diagnostics which have been applied to clinical contexts to translation of clinical standards for HIV and TB prevention into population level implementation in low resource settings.  Having recently joined the Georgetown University Infectious Diseases faculty, she looks forward to participating in clinical and epidemiologic studies that will directly impact on the local HIV epidemic within the District of Columbia and globally.  

Describe your research interests and how you chose this area of research.

I have had a fascination with infectious diseases since my early childhood growing up in Ethiopia.  Infectious diseases that are rare in other parts of the world were visibly present in day-to-day life, from the disfiguring effects of leprosy, to the episodic outbreaks of cholera and meningitis.  It is within this context that I experienced the emergence of HIV; my vantage point of the emerging HIV epidemic was through the eyes of an adolescent, and I was profoundly struck by the stigma and dissonance that resulted from the rise of this epidemic.

My early years as an intern in New York City were similarly influential.  Effective therapy was not yet broadly available, and our HIV inpatient rotations were busy.  We had easily five admissions each night, all patients with complications related to advanced HIV.  It is not very often in this country that we lose patients in their twenties to forties, but we lost many patients in that age range, almost all to HIV related complications.  The hollowed faces of individuals with AIDS related wasting and the absolute pallor of the pleading but sunken eyes of our patients was haunting.  And the resurrection of patients whose families had left for dead with the use of potent antiretroviral medications was intoxicating.

Taking these successes to those less fortunate in the developed country setting became a fervent goal early in my career.  This was exemplified in the work that I conducted in HIV drug resistance, treatment access and equity.   Though I have remained a treatment advocate since that time, the continued propagation of the epidemic compelled me to dedicate my efforts to prevention of HIV.  As a physician trained in both Internal Medicine and Pediatrics, the area of mother-to-child transmission prevention was compelling, especially since our prevention strategies could have the dual effect of treating and protecting mothers from the scourge of HIV disease progression, while preventing transmission to the infants.  

I was thus particularly excited with the emergence of data that effectively treating HIV among adults could result in a decrease in sexual transmission of HIV.  Yet here in Washington DC, I keep receiving referrals, young adults recently infected with the virus, some diagnosed only because they were coming in to the clinic because of pregnancy.  And others identified because of the aggressive HIV testing that takes place in this city with high HIV prevalence.  I was also struck by how many of my HIV-positive patients have friends or family members similarly afflicted by the virus.  These observations, availability of newer biomedical treatment and prevention strategies, and the potential to use state of the art molecular epidemiology in real time to curb the HIV epidemic were the drivers that led to my interest in the work that will be supported through this KL2 scholar opportunity.       

How does GHUCCTS help you to achieve your research goals and advance your career in clinical and translational research? How will the CTSA program help to advance knowledge and treatments for patients with the disease(s) you study?

The GHUCCTS provides critical resources that allow us to efficiently enroll new participants to identify factors that contribute to local HIV transmission dynamics.  Through creative use of technology, sampling strategies, and available resources, we hope to describe the social and geographic determinants of HIV transmission, to guide implementation of more effective treatment and prevention strategies with colleagues across metropolitan Washington DC. 

Why is it important to have both disciplinary and ethnic/cultural diversity in medical research? How does diversity contribute to your research? How does diversity enhance scientific discovery? (Examples from your own career would be particularly useful)

Many aspects of medicine are very humbling, but HIV particularly so as it continues to evade our earthly attempts at control and eradication.  The successes within HIV have been huge, with significant improvement in morbidity and mortality with the availability of effective therapies.  Yet human behavior and culture coupled with a rapidly evolving virus has taken the work needed to control this infection beyond that of medical providers.  Multi-disciplinary approaches have been critical to all the successes that have been made in this field.  I have been fortunate to have trained and worked with individuals spanning a number of fields, and it is that broader experience that led me to strive to incorporate the bench to bedside to population approach that is exemplified in this area of research. 

How does clinical translational research benefit our communities, both directly and indirectly? (Examples from your own research program would be particularly useful)

The research that I have proposed does not fall neatly into any one area of research.  It utilizes basic science approaches, including viral genetic sequencing and phylogenetics, but this approach is only impactful when coupled with clinical epidemiology, geographic spatial mapping, and network modeling to fully characterize HIV transmission dynamics.  Any singular approach would not provide sufficient information to inform treatment and prevention strategies.  The work that we propose will only be useful if it is coupled with detailed understanding of the acceptability of potential interventions to the communities most affected by the epidemic.  The research supported by the GHUCCTS thus builds on data generated through focus group discussions and surveys of women enrolled within the metropolitan DC Women’s Interagency HIV Study (WIHS) hosted at Georgetown University.  The underlying question that we are trying to address is driven by observations and queries raised by working with the most affected communities; and our approach in this translational research effort aims to ensure direct applicability to meaningfully impact on challenges faced by the community in this area of high HIV prevalence.  The ultimate goal of our project is to determine ways to identify individuals at highest risk of transmitting or acquiring HIV, and ensuring access to our newer treatment and prevention modalities during periods of high risk, to curb ongoing transmission of the HIV epidemic.  

September 22, 2015