When Jennifer Downs, M.D., Ph.D., M.Sc., first traveled to Mwanza, Tanzania in 2007, she was stunned by the numbers of young women who were hospitalized with advanced HIV infection. She was also struck by the very high rate of schistosomiasis, a parasitic worm infection, that affected people in the area. Schistosoma worms lay eggs that migrate through body tissues and cause damage to internal organs, including the reproductive tract, causing female genital schistosomiasis (FGS) in 40 million girls and women who live mostly in Africa. As Dr. Downs read more about FGS, she learned that one study had suggested a possible link between FGS and HIV infection. She wanted to learn more.
Dr. Downs returned to Mwanza the following year, during her infectious diseases fellowship, to initiate her first study on this topic. Working with a Tanzanian study team of nurses and parasitologists, she documented that women living in rural Tanzania were three times more likely to have HIV infection if they had schistosomiasis. It was her first focused research experience and she was hooked: she knew that she wanted to commit her career to working to solve neglected health problems among these and similar women. In particular, very little was known about whether standard praziquantel treatment for schistosomiasis would improve the gynecologic symptoms experienced by women with FGS, which include bleeding, vaginal discharge, pain, and infertility.
To investigate this question, Dr. Downs applied for and received a KL-2 award (2010-2012) through the Weill Cornell Clinical and Translational Science Center. For her KL-2 project, Dr. Downs initiated her first longitudinal study in Tanzania. She and her team treated women with FGS with praziquantel and followed them for 6 months to track improvement in their gynecologic abnormalities. Her study showed, alarmingly, that nearly 60% of women had persistent abnormalities after 6 months.
Dr. Downs spent the next several years working to understand the immune and molecular nature of abnormalities that may underlie women’s impaired responses to treatment. With NIH K23 support, she worked with Tanzanian colleagues to establish field and laboratory capacity for these studies in Mwanza. Her team identified abnormalities in the genital tract that could underlie susceptibility to HIV in women with FGS. Now, with NIH R01 support (AI168306), Dr. Downs and her team are using these techniques to determine which immune cells, mucosal abnormalities, and viruses are altered in women even after they are treated with praziquantel. This will have an impact solving the problem identified during her KL2 – that we lack adequate treatment for women with FGS. This work, therefore, builds on and directly extends the project she began during her KL-2 award.
The KL-2 award’s impact does not stop there. In March, Dr. Downs received an NIH K24 award, which supports mid-career scientists to mentor the next generation of scientists. “I am doing more and more mentoring and training of scientists, mostly physician-scientists, both in the US and Tanzania. It’s one of the best parts of my job,” she says. “I have had the privilege of having role models, including Dr. Imperato-McGinley (Weill Cornell CTSC PI), who exemplify being an exceptional woman scientist and mentoring the next generation of investigators. Her support of me has encouraged me to emphasize mentorship in my own career.”
