Indiana University Center for Global Health

Wools-Kaloustian named IU Center for Global Health Director of Research

Kara Wools-Kaloustian, MD, MS, has been named director of research for the Indiana University Center for Global Health (IUCGH). Wools-Kaloustian’s involvement with global health at IU stretches back to the early days of AMPATH, the university’s signature partnership in Eldoret, Kenya. She has worked with underserved and marginalized populations throughout her career and been at the forefront of international research program and infrastructure development.

Dr. Kara Wools-Kaloustian was in the first class of residents to complete a rotation as part of the IU-Kenya partnership in 1991, the first fellow to complete research as part of the partnership in 1992 and served as medicine team leader in 1993-94.

Wools-Kaloustian was in the first IU School of Medicine residency class to complete rotations at Moi University and Moi Teaching and Referral Hospital in Kenya in 1991 and the first fellow to conduct research as part of the partnership in 1992.

These early global health experiences shaped Wools-Kaloustian’s entire career. “I had been committed to providing healthcare to marginalized populations from the time that I entered medical school, but what I learned during my first residence rotation in Kenya was that I really enjoyed participating in improving health systems and creating systems where they did not previously exist,” she said.

She served as one of the earliest medicine team leaders from 1993-94 and, with support from the World AIDS Foundation, she established both an educational program about sexually transmitted infections (STIs) and HIV for healthcare providers, and an STI diagnostic laboratory in collaboration with the Faculty of Health Sciences at Moi University.

Wools-Kaloustian returned to Indianapolis to serve as the medical director for the Marion County sexually-transmitted diseases (STD) program and a member of the infectious disease faculty at IU School of Medicine from 1994-99. Her work in Kenya commenced again in 2003 when she became one of the founding co-directors of field research. Her groundbreaking work in establishing international collaborative research partnerships helped to build the foundation for IU’s global health research efforts that currently include 75 active protocols and more than $8.5 million in new research awards this fiscal year.

Establishment of the Burnt Forest HIV clinic in Kenya (pictured) and drafting of the first two editions of the AMPATH HIV Care and Treatment guidelines were efforts in which Wools-Kaloustian played a pivotal role.

The development of the Open Medical Records System, establishment of the Burnt Forest HIV clinic in Kenya, and drafting of the first two editions of the AMPATH HIV Care and Treatment guidelines were other landmark efforts in which Wools-Kaloustian played a pivotal role.

Her research portfolio is focused on HIV in resource-limited settings and includes clinical trials, implementation science and epidemiology. She has conducted research related to both adults and children with HIV, prevention of mother-to-child transmission of HIV, and HIV complications that have improved the treatment and care of patients around the world.

Recent research

A recent example of Wools-Kaloustian’s international research projects was published this spring in The Lancet HIV. The project demonstrates the complexity of global health research. The global collaborative study to determine how long children stay on their first treatment for HIV involved reviewing clinical data from multiple groups of the youngest HIV patients from more than 50 countries. Pediatric leaders for each geographic group were involved in developing the initial concept and in helping pull together and understand the data from their group. Each group had to package their data in different ways and send it to the University of Cape Town for the initial merging of the data. The data was then sent to University College London for data cleaning and analysis. Overall, the study took about five years to complete.

The study found that when original drug regimens are not effective, children from countries with better resources and testing move to new drug regiments more quickly than their peers in areas with fewer resources such as sub-Saharan Africa.

“We need to understand how this delay in change is going to impact children’s health,” Wools-Kaloustian said. “Are we going to have worse outcomes in these kids because their treatment is delayed? We think treatment is failing for more kids than are getting switched. This shows the need for advocacy for better monitoring so that we can identify the kids that are failing earlier and advocate for better, more durable regimens for kids and for better clinical trials for antiretrovirals (HIV drugs) for kids so we are starting out with optimal regimens,” she said.

“Like much of my work, the answers here lead to more questions,” concluded Wools-Kaloustian

“I entered medical school the year that HIV was discovered to be the virus that causes AIDS. By the time I started my clinical rotations in 1986 there was a test for HIV, but there was no treatment, and the life expectancy from diagnosis to death was about a year,” said Wools-Kaloustian. “As I progressed through my training, even though it was clear that HIV could not be spread by casual contact, my patients’ trays were left outside their rooms where they couldn’t get to them, some people would gown and glove just to enter a patient room, and very few people would touch patients that had HIV,” she continued.

Recalling experiences when other medical trainees would don a full gown, gloves and a mask just to ask the patient questions, Wools-Kaloustian said, “Ultimately I felt that people with HIV needed a voice, someone who was willing to care for them, and touch them without fear.”

Wools-Kaloustian is the principal investigator for the East Africa IeDEA (EA-IeDEA) consortium, one of seven regional data centers funded by the National Institutes of Health to provide global HIV/AIDS data. As part of this consortium, IU works closely with HIV treatment sites throughout Kenya, Tanzania and Uganda to maintain data on more than 320,000 adults and 64,000 children. Overall, the IeDEA regional data centers have the capacity to merge, share and analyze data for more than 1.7 million HIV patients worldwide.

Wools-Kaloustian believes that IU is a global health leader because of the commitment to replicating the traditional tripartite mission (care, training and research) of U.S. academic health centers. “It is imperative that we continue to serve as a model for sustainable, reciprocal, and mutually-beneficial global health academic partnerships while expanding the geographic and specialty scope of the IUCGH research portfolio,” she said.

With this background in mind, Wools-Kaloustian has two major areas of focus:

  • Enhance the global health resources and opportunities for all global health researchers within IU while remaining true to the center’s focus on partnership
  • Leverage AMPATH’s innovative care, treatment, and population health programs to develop a world-class Implementation Science Team.

“Kara has been an integral member of both the AMPATH partnership and Indiana University’s global health efforts from the beginning,” said Bob Einterz, MD, director of the IU Center for Global Health. “She carries the history of the program with her and has contributed more throughout her career than any other resident who has come through the training program. The global health research program will flourish under her leadership,” Einterz concluded.