Projects - Peru

Project Name:  Implementation of the Community Health System Innovation (COHESION-I) in low- and middle-income countries
Institution:  Center of Excellence in Chronic Conditions (CRONICAS)
Mentor:  Amalia Pesantes

This project aims to generate health systems research evidence about the best practices to improve patient satisfaction and responsiveness by focusing on the expectations and demands of those who provide care and those who use the health system for chronic conditions. This study will take place in 4 countries: Peru, Nepal, Mozambique and India.

It is a continuation of a project (COHESION) that started in 2016 as an international collaboration between Mozambique, Nepal, Peru and Switzerland to develop interventions that would improve PHC services for chronic care.


Project Name:  Innovations using mHealth for people with dementia and other co-morbidities
Institution:  Center of Excellence in Chronic Conditions (CRONICAS)
Mentor:  Antonio Bernage-Ortiz

Innovations using mHealth for People with Dementia and other co-morbidities and their carer givers (IMPACT)

Project IMPACT will use dementia as a tracer condition to strengthen health systems in Latin America through sustainable, integrated, person-centred, community-delivered, technology-enabled innovation. Our specific objectives are to:

i) Evaluate health systems readiness to provide support for PWD

ii) Develop and implement an mHealth application for diagnosis of dementia by community health workers (CHWs) in Peru

iii) Determine the feasibility of an mHealth-delivered, CHW-supported intervention to improve health-related quality of lifefor PWD and their carers

iv) Assess the socioeconomic burden of dementia in Peru.

Through these objectives and in combination with our outreach, capacity building and engagement activities, we will identify barriersand facilitators for high-quality health systems.


Project Name:  Transcriptomic identification of cellular determinants in the in vitro transition from metacestode larva (cysticercus) to adult worm in Taenia solium
Institution:  Center of Excellence in Chronic Conditions (CRONICAS)
Mentor:  Cristina Guerra Giraldez

Taenia solium is endemic in Peru and other developing countries where informal breeding of pigs and scarce control of meat for human consumption maintain the parasite's life cycle. Infection of the brain with its larvae (cysticerci) causes neurocysticercosis. The adult form, a flatworm that can only grow in the human intestine, produces microscopic eggs by self-fertilization and eliminates them in the infected person's feces. When pigs and humans consume water or food contaminated with T. solium's eggs, these develop into cysticerci that reach different human and porcine tissues. Viable cysticerci are present in poorly cooked infected pig meat. Unclear events activate the ingested cysticercus in the human intestine: its head evaginates from the larval vesicle and adheres to the intestinal epithelium. The body grows from the neck, developing into the adult hermaphrodite stage.

Pathways such as Wnt and Notch control the in vitro development of minor parasitic flatworms established recently as laboratory models. T. solium cysticerci and some previous stages can be maintained in vitro, but there are no protocols that replicate their development into the adult stage in the laboratory to allow its systematic study. Therefore, much of the biology of this parasite remains undescribed. We will use transcriptomics and in situ hybridization to identify the cell signaling pathways responsible for the metamorphosis of a cysticercus into an adult worm.

Our group has halted the evagination of T. solium in vitro by inhibiting the Notch pathway; we observed changes in the transcription of some genes related to this pathway. We aim to identify components of this and other developmental pathways that determine and direct the cell proliferation of T. solium, essential for generating an adult worm. These components will be considered potential targets to control the growth of the intestinal worm, thus inhibiting the production of infectious eggs and the spread of the parasite. The project involves in vitro maintenance and some imaging of T. solium cysticerci, nucleic acid extraction, preparation of cDNA libraries, and analysis of RNAseq data. Two moments to collect cysticerci include working with veterinarians in the necropsy of infected pigs obtained in a rural setting.