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  • Key Partners: Prisma, Universidad Peruana Cayetano Heredia, Emory Rollins School of Public Health, The University of Georgia, Washington University

    Biomass fuel smoke is a leading risk factor for the burden of disease worldwide. International campaigns are promoting the widespread adoption of liquefied petroleum gas (LPG) in resource-limited settings. However, it is unclear if the introduction and use of LPG stoves in settings where biomass fuels are used daily reduces pollution concentration exposure, improves health outcomes, or how cultural and social barriers influence the exclusive adoption of LPG stoves.

    The CHAP study is based in high altitude Puno, Peru, where many cook with wood, dung, and crop residues over a traditional stove. CHAP is a randomized, controlled field intervention trial which aims to test the impact of LPG adoption on household air pollution and cardiopulmonary health compared to traditional stove use. The main outcomes include: 1) household air pollution (particulate matter (PM2.5) and carbon monoxide), 2) cardiovascular health (blood pressure, endothelial function, atherosclerosis progression, and inflammatory metabolites in urine and blood), 3) respiratory health (peak expiratory flow and forced expiratory volume), 4) quality of life, 5) level of LPG stove adoption based on LPG stove use and exhaled CO concentrations, and 6) diet and salt intake.

    The study will enroll 180 non-pregnant, adult women (aged 25-64 years) over the course of one year. After completing baseline measurements, women will be randomly assigned to intervention or control groups. During the first year, women in the intervention arm will receive a free stove and fuel (10 kg tanks delivered to their household bi-weekly); control participants will continue to use their traditional stoves. During the second year, intervention participants will keep their stove but must pay for LPG; control participants will receive a free LPG stove and vouchers to cover one year of free LPG.

    The CHAP trial is a collaboration between Johns Hopkins University, Washington University School of MedicineUniversity of Georgia, Emory UniversityUniversidad Peruana Cayetano Heredia, and Asociación Benéfica Prisma.

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  • Key Partners: UCL, Prisma, Universidad Peruana Cayetano Heredia, Makerere Institute of Medicine Nepal, University of York

    Self-management of chronic respiratory illness has the potential to bring relief and improved quality of life to people who are not able to easily seek care at health facilities. The GECO cohort aims to first assess the diagnostic accuracy of a short COPD case-finding questionnaire before determining the clinical effectiveness, cost-effectiveness, and feasibility of implementation of a self-directed COPD Action Plan in three varying LMIC settings.

    The cohort will include an age- and sex-stratified random sample of approximately 12,000 adults age ≥40 years in Bhaktapur, Nepal; Lima, Peru; and Nakaseke, Uganda, each of which have been found to have a high prevalence of COPD. Each participant will have basic demographic information collected as well as anthropological measurements and spirometry testing. Those with COPD will be administered additional questionnaires, such as the LFQ, CAPTURE, MRC Dyspnea Scale, SGRQ, and EQ-5D. Based on current prevalence estimates, we anticipate recruiting 1,200 adults with COPD into the later stages of the study. Those who are enrolled will receive standardized COPD self-management education by trained Community Health Workers before being randomized into Action Plan or Standard Care groups. These groups will be followed up for one year with additional survey data collected.

    This cohort will be funded by the Medical Research Council of the United Kingdom as a collaboration between University College London (UK), Johns Hopkins University (USA), AB PRISMA (Peru), Cayetano Heredia University (Peru), York University (UK), Makerere University (Uganda), and the Institute of Medicine (Nepal).

  • Key Partners: National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI), Bill and Melinda Gates Foundation, Berkeley Air Monitoring Group, Colorado State University, Global Alliance for Clean Cookstoves, Global LPG Partnership, Harvard University, Johns Hopkins University, London School of Hygiene and Tropical Medicine, Asociación Benéfica Prisma, Sri Ramachandra University, Universidad del Valle, Guatemala, Universidad Peruana Cayetano Heredia, University of Georgia, Washington University School of Medicine, University of Rwanda, Eagle Research Center, University of Oxford

    The HAPIN cohort consists of participants living in rural settings in Puno, in southeastern Peru at the shores of Lake Titicaca at 3,825 meters above sea level. Study participants live in rural villages of the Puno Province, where biomass fuels are the primary source of fuel for cooking.  Using a rolling recruitment process, we are recruiting 800 pregnant women (one per household) and an additional 200 older adult women from the same households who meet inclusion/exclusion criteria. At birth, parents will be approached to consent for their newborn child to participate in the study.

    Characteristics of pregnant women enrolled:

    • Aged 18 to 34 years
    • Less than 20 weeks gestation confirmed by ultrasound
    • Singleton pregnancy
    • No fetal anomalies identified during first ultrasound
    • Usually uses a biomass stove
    • Not currently a smoker
    • No plans* to move out of current household in next 30 months
    • Agrees to participate with informed consent
    • BMI less than or equal to 40 kg/m2

    Characteristics of pregnant women enrolled:

    • Aged 35 to 64 years
    • Not currently a smoker
    • Resides in household with participating pregnant woman and has no plans* to move out of current household in next 30 months
    • Agrees to participate with informed consent
    • Does not use anti-hypertensives

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  • Key Partners: Prisma

    Sleep disordered breathing (SDB) is a prevalent disease that is linked to cardiovascular disease. The prevalence and severity of SDB are amplified at high altitudes, in which an estimated 150 million people live worldwide. In Puno, Peru (3825m above sea level), we documented an ~80% prevalence of SDB in a population-based community sample, indicating that highlanders are exposed to significant reductions in oxyhemoglobin saturation and recurrent apneic episodes during sleep. We demonstrated that (1) sleep greatly amplifies daytime hypoxemia and exposes subjects to recurrent apneic episodes, (2) oxygenation improves markedly when highlanders sleep on an incline rather than in the horizontal plane, and (3) SDB in highlanders is closely linked to markers of cardiometabolic stress.

    The SALTA trial will investigate if a simple, readily deployed nocturnal postural maneuver will effectively treat SDB and reduce cardiometabolic stress. SALTA is a 12-week Phase II randomized controlled clinical trial in 60 adults with BMI ≥25 kg/m2 living in urban Puno. The trial aims to assess the therapeutic efficacy of inclined sleep posture on SDB. Secondary aims include documenting adherence to sleeping on an inclined plane and to what degree postural therapy decreases markers of cardiometabolic stress, including metabolic dysfunction, cardiovascular stress, and markers of hypoxemia.

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