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:

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

Mobile Phone Ownership and Use Among Women Screening for Cervical Cancer in a Community-Based Setting in Western Kenya: Observational Study.

BACKGROUND: Mobile phone ownership among women of reproductive age in western Kenya is not well described, and our understanding of its link with care-seeking behaviors is nascent. Understanding access to and use of mobile phones among this population as well as willingness to participate in mobile health interventions are important in improving and more effectively implementing mobile health strategies. OBJECTIVE: This study aims to describe patterns of mobile phone ownership and use among women attending cervical cancer screening and to identify key considerations for the use of SMS text message-guided linkage to treatment strategies and other programmatic implications for cervical cancer screening in Kenya. METHODS: This analysis was nested within a cluster randomized trial evaluating various strategies for human papillomavirus (HPV)-based cervical cancer screening and prevention in a rural area in western Kenya between February and November 2018. A total of 3299 women were surveyed at the time of screening and treatment. Questionnaires included items detailing demographics, health history, prior care-seeking behaviors, and patterns of mobile phone ownership and use. We used bivariate and multivariable log-binomial regression to analyze associations between independent variables and treatment uptake among women testing positive for high-risk HPV. RESULTS: Rates of mobile phone ownership (2351/3299, 71.26%) and reported daily use (2441/3299, 73.99%) were high among women. Most women (1953/3277, 59.59%) were comfortable receiving their screening results via SMS text messages, although the most commonly preferred method of notification was via phone calls. Higher levels of education (risk ratio 1.23, 95% CI 1.02-1.50), missing work to attend screening (risk ratio 1.29, 95% CI 1.10-1.52), and previous cervical cancer screening (risk ratio 1.27, 95% CI 1.05-1.55) were significantly associated with a higher risk of attending treatment after testing high-risk HPV-positive, although the rates of overall treatment uptake remained low (278/551, 50.5%) among this population. Those who shared a mobile phone with their partner or spouse were less likely to attend treatment than those who owned a phone (adjusted risk ratio 0.69, 95% CI 0.46-1.05). Treatment uptake did not vary significantly according to the type of notification method, which were SMS text message, phone call, or home visit. CONCLUSIONS: Although the rates of mobile phone ownership and use among women in western Kenya are high, we found that individual preferences for communication of messages about HPV results and treatment varied and that treatment rates were low across the entire cohort, with no difference by modality (SMS text message, phone call, or home visit). Therefore, although text-based results performed as well as phone calls and home visits, our findings highlight the need for more work to tailor communication about HPV results and support women as they navigate the follow-up process.
Authors
Stocks, J; Ibrahim, S; Park, L; Huchko, M
MLA Citation
Stocks, Jacob, et al. “Mobile Phone Ownership and Use Among Women Screening for Cervical Cancer in a Community-Based Setting in Western Kenya: Observational Study.Jmir Public Health Surveill, vol. 8, no. 6, June 2022, p. e28885. Pubmed, doi:10.2196/28885.
URI
https://scholars.duke.edu/individual/pub1523751
PMID
35671089
Source
pubmed
Published In
Jmir Public Health and Surveillance
Volume
8
Published Date
Start Page
e28885
DOI
10.2196/28885

Uptake and correlates of cervical cancer screening among women attending a community-based multi-disease health campaign in Kenya.

INTRODUCTION: Despite the increased risk of cervical cancer among HIV-positive women, many HIV-care programs do not offer integrated cervical cancer screening. Incorporating self-collected Human Papillomavirus (HPV) testing into HIV programs is a potential strategy to identify women at higher risk for cervical cancer while leveraging the staffing, infrastructure and referral systems for existing services. Community-based HIV and HPV testing has been effective and efficient when offered in single-disease settings. METHODS: This cross-sectional study was conducted within a community outreach and multi-disease screening campaigns organized by the Family AIDS Care and Education Services in Kisumu County, Kenya. In addition to HIV testing, the campaigns provided screening for TB, malaria, hypertension, diabetes, and referrals for voluntary medical male circumcision. After these services, women aged 25-65 were offered self-collected HPV testing. Rates and predictors of cervical cancer screening uptake and of HPV positivity were analyzed using tabular analysis and Fisher's Exact Test. Logistic regression was performed to explore multivariate associations with screening uptake. RESULTS: Among the 2016 women of screening age who attended the outreach campaigns, 749 women (35.6%) were screened, and 134 women (18.7%) were HPV-positive. In bivariate analysis, women who had no children (p < 0.01), who were not pregnant (p < 0.01), who were using contraceptives (p < 0.01), who had sex without using condoms (p < 0.05), and who were encouraged by a family member other than their spouse (p < 0.01), were more likely to undergo screening. On multivariable analysis, characteristics associated with higher screening uptake included: women aged 45-54 (OR 1.62, 95% CI 1.05-2.52) compared to women aged 25-34; no children (OR 1.65, 95% CI 1.06-2.56); and family support other than their spouse (OR 1.53, 95% CI 1.09-2.16). Women who were pregnant were 0.44 times (95% CI 0.25-0.76) less likely to get screened. Bivariate analyses with participant characteristics and HPV positivity found that women who screened HPV-positive were more likely to be HIV-positive (p < 0.001) and single (p < 0.001). CONCLUSIONS: The low screening uptake may be attributed to implementation challenges including long waiting times for service at the campaign and delays in procuring HPV test kits. However, given the potential benefits of integrating HPV testing into HIV outreach campaigns, these challenges should be examined to develop more effective multi-disease outreach interventions.
Authors
Choi, Y; Ibrahim, S; Park, LP; Cohen, CR; Bukusi, EA; Huchko, MJ
MLA Citation
Choi, Yujung, et al. “Uptake and correlates of cervical cancer screening among women attending a community-based multi-disease health campaign in Kenya.Bmc Womens Health, vol. 22, no. 1, Apr. 2022, p. 122. Pubmed, doi:10.1186/s12905-022-01702-4.
URI
https://scholars.duke.edu/individual/pub1518262
PMID
35436908
Source
pubmed
Published In
Bmc Women'S Health
Volume
22
Published Date
Start Page
122
DOI
10.1186/s12905-022-01702-4

Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study.

BACKGROUND: To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)-based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. OBJECTIVE: The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. METHODS: A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. RESULTS: A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada's impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. CONCLUSIONS: Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs.
Authors
Stocks, J; Choi, Y; Ibrahim, S; Huchko, M
MLA Citation
Stocks, Jacob, et al. “Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study.Jmir Form Res, vol. 6, no. 2, Feb. 2022, p. e27501. Pubmed, doi:10.2196/27501.
URI
https://scholars.duke.edu/individual/pub1512433
PMID
35200151
Source
pubmed
Published In
Jmir Formative Research
Volume
6
Published Date
Start Page
e27501
DOI
10.2196/27501

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