Megan Huchko

Overview:

Megan Huchko, MD, MPH, holds a dual appointment as an Associate Professor in the Department of Obstetrics & Gynecology and the Duke Global Health Institute.  Dr. Huchko was an undergraduate at Duke before moving to New York City to complete medical school at the Albert Einstein College of Medicine, and residency training at Columbia Presbyterian Medical Center.  She completed her fellowship in Reproductive Infectious Disease the University of California, San Francisco, and was a faculty member there. 

Dr. Huchko practices as an ob/gyn generalist and specializes in cervical cancer prevention through her clinical work and global women’s health research.  Her research focuses on optimizing the diagnosis and treatment of cervical cancer among vulnerable women in settings where health disparities occur. She has been working with the Family AIDS Care and Education Services (FACES) program in the Nyanza Province of western Kenya since 2006.  

She designed and implemented a cervical cancer screening and prevention (CCSP) program for HIV-infected women enrolled in care at FACES.  The CCSP program has provided a clinical resource, as well as a cohort to evaluate the epidemiology of cervical cancer among HIV-infected women, the feasibility of integrating cervical cancer prevention programs into HIV and general outpatient clinics, the safety of various diagnostic and treatment modalities, the efficacy of low-cost/low-resource screening modalities in HIV-infected women and provider and patient-level barriers and facilitators to uptake of cervical cancer prevention activities.  

Currently, she is carrying out several large studies in central Uganda and western Kenya to evaluate the optimal implementation strategy for HPV-based cervical cancer screening in rural settings.  At Duke, she leads the Center of Excellence in Global Women’s Health through the Global Health Institute and serves as Director for the Ob/Gyn Clinical Research Unit (CRU).

Positions:

Hollier Family Associate Professor of Global Health

Obstetrics and Gynecology, Women's Community & Population Health
School of Medicine

Associate Professor of Obstetrics and Gynecology

Obstetrics and Gynecology, Women's Community & Population Health
School of Medicine

Associate Research Professor of Global Health

Duke Global Health Institute
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 1997

Duke University

M.D. 2002

Yeshiva University, Albert Einstein College of Medicine

M.P.H. 2007

University of California - Berkeley

Grants:

Developing a tool to measure cervical cancer stigma among HIV+ women in Kenya

Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

mHealth-supported telecolposcopy for cervical cancer screening in low-resource settings

Administered By
Center for Health Policy & Inequalities Research
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

mHealth-supported telecolposcopy for cervical cancer programs in low-resource settings.

Administered By
Center for Health Policy & Inequalities Research
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Evaluating a Community-Driven Cervical Cancer Prevention Strategy in Western Kenya

Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Developing a tool to measure cervical cancer stigma among HIV+ women in Kenya

Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya.

BACKGROUND: Cervical cancer screening through self-collected high-risk human papillomavirus (HPV) testing has increased screening uptake, particularly in low-resource settings. Improvement ultimately depends, however, on women with positive results accessing follow-up treatment. Identifying the barriers to timely treatment is needed to tailor service delivery for maximum impact. MATERIALS AND METHODS: This qualitative study was conducted within a self-collected HPV screening trial in Migori County, Kenya. HPV-positive women were referred for no-cost cryotherapy treatment at the county hospital. Women not attending within 60 days of receiving HPV-positive results were randomly selected for in-depth interviews (IDIs). IDIs were coded and analyzed to develop an analytical framework and identify treatment barriers. RESULTS: Eighty-one women were interviewed. IDIs showed a poor understanding of HPV and cervical cancer, impacting comprehension of screening results and treatment instructions. All 81 had not undergone treatment but reported intending to in the future. Eight reported seeking treatment unsuccessfully or not qualifying, primarily due to pregnancy. Transportation costs and long distances to the hospital were the most reported barriers to treatment. Other obstacles included work, household obligations, and fear of treatment. Impacts of social influences were mixed; some women reported their husbands prevented seeking treatment, others reported their husbands provided financial or emotional support. Few women experienced peer support. CONCLUSIONS: Women faced many barriers to treatment following HPV screening in rural Kenya. Transportation barriers highlight a need for local treatment capacity or screen-and-treat approaches. Ensuring women understand their results and how to seek treatment is essential to improving cervical cancer screening in low-resource settings.
Authors
Isaacson, S; Adewumi, K; Smith, JS; Novak, C; Oketch, S; Huchko, MJ
MLA Citation
Isaacson, Sinéad, et al. “A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya.Oncologist, vol. 28, no. 1, Jan. 2023, pp. e9–18. Pubmed, doi:10.1093/oncolo/oyac208.
URI
https://scholars.duke.edu/individual/pub1554112
PMID
36239434
Source
pubmed
Published In
Oncologist
Volume
28
Published Date
Start Page
e9
End Page
e18
DOI
10.1093/oncolo/oyac208

Development and initial validation of a pictorial survey to assess for symptomatic pelvic organ prolapse and urinary incontinence in western Kenya.

INTRODUCTION AND HYPOTHESIS: Visual tools are a valuable tool for ascertaining patient symptoms, especially in populations with low literacy rates. The objective was to develop and validate a pictorial scale for assessing symptomatic pelvic organ prolapse (POP) and urinary incontinence among women in western Kenya. METHODS: Illustrations of POP, stress urinary incontinence (SUI), and urgency urinary incontinence (UUI) were developed by an artist. Virtual Zoom interviews were conducted with gynecology providers in Kisumu soliciting feedback on the illustrations. Cognitive interviews with patients were then conducted. Validation of the illustrations was performed against the gold standard of clinical history and examination amongst patients presenting for outpatient care at three Kisumu hospitals. RESULTS: Sixteen provider interviews were conducted. The illustrations were revised to reflect each disorder more clearly, and performed well during cognitive interviews with 8 patients (aged 21 to 76). One hundred patients were included in the validation study. Nine patients had symptomatic POP, whereas 32 had UUI and 25 had SUI. Sensitivity and specificity for the SUI illustration was 80% (95% CI 61-91%) and 97% (95% CI 72-98%) and for UUI they were 81% (95% CI 65-91%) and 99% (95% CI 92-100%) respectively. POP illustrations had lower sensitivity and specificity, with the best performing illustration having sensitivity of 67% (95% CI 35-88%) and specificity of 99% (95% CI 94-100%), which improved when only bulge or pressure symptoms were included. CONCLUSIONS: We present a newly developed pictorial scale to assess for clinical urinary incontinence and POP that may be adapted and evaluated in other settings for clinical and research purposes.
Authors
O'Shea, M; Omoto, J; Huchko, M; Gwer, S
MLA Citation
O’Shea, Michele, et al. “Development and initial validation of a pictorial survey to assess for symptomatic pelvic organ prolapse and urinary incontinence in western Kenya.Int Urogynecol J, vol. 33, no. 9, Sept. 2022, pp. 2515–23. Pubmed, doi:10.1007/s00192-022-05214-5.
URI
https://scholars.duke.edu/individual/pub1526880
PMID
35773529
Source
pubmed
Published In
Int Urogynecol J
Volume
33
Published Date
Start Page
2515
End Page
2523
DOI
10.1007/s00192-022-05214-5

Developing a framework to describe stigma related to cervical cancer and HPV in western Kenya.

BACKGROUND: Despite a high prevalence of human papillomavirus (HPV) and cervical cancer in low and middle-income countries, stigma remains an issue. Addressing HPV and cervical cancer stigma could significantly improve health outcomes for these conditions. The objective of this study was to identify the manifestations of stigma and their potential impacts on health-seeking behavior. METHODS: Twenty-six in-depth interviews were conducted with women living with HIV, HIV-negative women, community health volunteers, and health care providers in Kisumu, Kenya in 2019. The interviews were designed to draw out existing attitudes or experiences related to stigma within the community. We conducted a thematic analysis of the interviews to identify internalized, anticipated, and discriminatory attitudes. RESULTS: Within internalized attitudes, a prominent observed theme was a fear of death associated with a positive HPV test. This stemmed from a lack of understanding of differences between HPV and cervical cancer and posed a significant barrier for women deciding to seek screening or to continue with treatment. Discriminatory attitudes of community members, including assumptions of promiscuity, infidelity, or HIV status, were perceived to prevent women from accessing screening and treatment opportunities. The interviews also exhibited a limited awareness of HPV in this region, which may have contributed to a lack of enacted stigma towards people living with HPV or cervical cancer. CONCLUSION: Stigma has the potential to lead to decreased screening and treatment uptake through its drivers. This includes a decreased perception of personal risk due to a lack of knowledge, which results in increased HPV-risk behaviors. Future research must focus on creating and integrating stigma-reducing interventions, primarily to encourage women to seek out primary and secondary preventative measures.
Authors
Ginjupalli, R; Mundaden, R; Choi, Y; Herfel, E; Oketch, SY; Watt, MH; Makhulo, B; Bukusi, EA; Huchko, M
MLA Citation
Ginjupalli, Ramya, et al. “Developing a framework to describe stigma related to cervical cancer and HPV in western Kenya.Bmc Womens Health, vol. 22, no. 1, Feb. 2022, p. 39. Pubmed, doi:10.1186/s12905-022-01619-y.
URI
https://scholars.duke.edu/individual/pub1509276
PMID
35148778
Source
pubmed
Published In
Bmc Women'S Health
Volume
22
Published Date
Start Page
39
DOI
10.1186/s12905-022-01619-y

Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspección Visual con Ácido Acético System: Mixed Methods Case Study (Preprint)

Authors
Reid, HW; Proeschold-Bell, RJ; Makarushka, C; Melgar Vega, KD; Huchko, M; Jeronimo, J; Vasudevan, L
MLA Citation
URI
https://scholars.duke.edu/individual/pub1524788
Source
crossref
Published Date
DOI
10.2196/preprints.32577

A Novel, Versatile Speculum-free Callascope for Clinical Examination and Self-Visualization of the Cervix

<h4>Background</h4> Invasive cervical cancer is preventable, yet affects 500,000 women worldwide each year, and over half these women die. Barriers to cervical cancer screening include lack of awareness of cervical cancer and the cervix, fear of the speculum, and lack of women-centric technologies. We developed a low-cost (∼$50), cervix-imaging device called the Callascope, which comprises an imaging component, camera and inserter that eliminates the need for a speculum and enables self-insertion. We sought to assess the quality of physicians’ images of the cervix using the Callascope versus the speculum in live patients and study women’s willingness to independently use the Callascope to image their cervix. <h4>Methods</h4> We conducted two main studies: (1) a clinical study in which a physician imaged the cervix of patients using both the speculum and Callascope in a 2×2 crossover design; and (2) home-based self-cervix imaging with the Callascope. <h4>Results</h4> Participants of the clinical study (n=28) and home study (n=12) all indicated greater comfort and an overall preference for the Callascope over the speculum. The clinical study data indicated that the Callascope enabled similar visualization compared to the speculum while significantly improving patient experience. With physician insertion and manipulation, the Callascope enabled cervix visualization for 82% of participants. In the home-study, 83% of participants were able to visualize their cervix with the Callascope on the first try and 100% after multiple attempts. <h4>Conclusion</h4> The Callascope is more comfortable and provides similar visualization to the speculum. The Callascope can be used by medical providers for clinical exams while also enabling home self-screening for cervical cancer and promoting a better understanding of one’s cervix to increase awareness of cervical screening needs. The Callascope may increase cervical cancer screening rates through reducing barriers including cost, discomfort, lack of awareness and stigma.
Authors
Asiedu, M; Agudogo, J; Dotson, ME; Krieger, M; Schmitt, J; Huchko, M; Suneja, G; Proeschold-Bell, RJ; Smith, J; Jenson, D; Hogan, W; Ramanujam, N
MLA Citation
URI
https://scholars.duke.edu/individual/pub1440909
Source
epmc
Published Date
DOI
10.1101/618348