Career Pathways—Explore the Possibilities, Epidemiologist

Interview with Nuha Naqvi, M.P.H., Global Surveillance Fellow at the Centers for Disease Control and Prevention (CDC)

Interviewed by Evelien van Gelderen, postbac in the Translational Autoinflammatory Diseases Section of the Laboratory of Clinical Immunology and Microbiology

The “Career Pathways—Explore the Possibilities” series highlights different professions pursued by scientists like you. This interview focuses on an epidemiologist, someone who studies patterns of disease and distribution within a population. Nuha Naqvi was a postbac fellow at NIAID for two years, where she worked in the Laboratory of Immunoregulation under the supervision of Irini Sereti, M.D. Read this interview with Nuha to learn more about her journey to becoming a survey epidemiologist.

What research were you engaged in at NIAID?

In the HIV Pathogenesis Section of the Laboratory of Immunoregulation, our main research focus was studying inflammatory complications in HIV and tuberculosis (TB), including immune reconstitution inflammatory syndrome (IRIS). IRIS is an aberrant immune response that presents with an overwhelming inflammatory reaction during immune restoration in patients with HIV infection and severe CD4 lymphopenia after initiation of antiretroviral therapy. Under the guidance of Dr. Irini Sereti and Dr. Maura Manion, my research primarily focused on evaluating the impact of viremia and lymphopenia on complement factors/inhibitors in HIV patients, optimizing a flow assay to observe latent viral reservoir and cell diversity in lymph nodes of virally suppressed patients, investigating the effects of TB-associated IRIS on HIV-infected cells, and observing the relationship between histoplasmosis and unmasking/paradoxical IRIS. While joining our clinicians in the outpatient clinic and intensive care unit, I also witnessed the impact of AIDS and TB from a clinical standpoint. My postbac allowed me to experience the true convergence of bedside-to-benchwork science.

Can you describe your current role?

I am currently supporting the CDC as a global surveillance fellow and survey epidemiologist in South Africa, conducting survey and surveillance operative research under the Epidemiology and Strategic Information Branch. In this role I support the implementation of the South African National HIV Prevalence, Incidence, Behavior, and Communication Survey assessing HIV seroprevalence, community viral load, and drug resistance on a population level. This project supports the UNAIDS 95–95–95 targets, which aim to ensure that by 2030, 95% of people living with HIV are tested and diagnosed, 95% of people diagnosed with HIV are receiving treatment, and 95% of people on treatment have a suppressed viral load. In South Africa there is currently a gap in reaching the second “95” target, especially among men; therefore, we are elucidating what challenges are being encountered by men when initiating in HIV treatment programs. Another research protocol I lead explores challenges faced when linking HIV-positive adolescents and young adults to clinical care and at-risk adolescents to pre-exposure prophylaxis (PrEP), which prevents HIV transmission from sex or injection drug use. Overall, we are aiming to utilize survey data and statistical analyses to better understand what barriers and challenges are being faced by key populations during initiation and retention in care.

What are the most challenging and most rewarding aspects of your current role?

It has been incredibly rewarding to experience epidemiology in the field and to take part in hands-on community surveillance work with implementing partners. Assisting a team that trains field workers on how to conduct HIV rapid tests and dried blood spot (DBS) collection, as well as how to transport blood samples from the field to mobile laboratories. Recently I’ve begun delivering sensitivity trainings to HIV index testing providers for interacting with survivors of gender-based violence—a driver of HIV transmission in this region. One of the most challenging aspects has been ensuring that studies are developed within the cultural context of the population that is being supported. Public health initiatives cannot be created in a vacuum, and my experiences thus far have reinforced the importance of successful programs being multifaceted with team members from a wide array of disciplines—including the local community.

How did you decide to pursue a position at the CDC after working at NIAID? What other career paths were you considering?

In the second year of my fellowship, I began exploring the next steps of my career. I was—and still am today—considering a Ph.D. program in infectious diseases. But at the time, I did not know exactly what aspect of research I wanted to study. While still intrigued by the microbiology and immunology of infectious diseases, my experiences had also shaped an interest in disease surveillance and outbreak investigation. This opportunity with the CDC allows me to combine my passions while mastering epidemiology and laboratory methodology to further understand how disease patterns differ among populations globally. In the long term, I see myself conducting field research focused on emerging disease ecology and the One Health approach to disease management.

How was the transition from your postbac at NIAID to your current role at CDC?

The transition from NIAID to CDC felt quite natural. Exposure to clinical research and experimental design made me a better scientist, through critical thinking and the ability to adapt experiments to different parameters. Understanding the fundamentals of traditional bench science is critical to macro-level population studies. The studies I am now conducting require a high-level understanding of biology, disease transmission, and laboratory diagnostics. While my focus is now on field research and implementation science, the skills and knowledge I learned while at NIAID prepared me to be a public health scientist and epidemiologist on an international scale.

Tell me about your experience at Tulane University School of Public Health and Tropical Medicine. Does what you learned during your M.P.H. inform your current work?

Through the M.P.H. program I obtained hands-on instruction on tropical disease pathogens, their vectors, and the management, treatment, and prevention of infectious diseases. I found myself enthralled by viral hemorrhagic fever pathophysiology and transmission research. My practicum research focused on developing teaching modules to improve Lassa fever early referral rates and rapid diagnostic test (RDT) usage in peripheral health units across the Kenema District in the eastern province of Sierra Leone, while also studying the seroprevalence of the Lassa virus across the country. My time in West Africa became the catalyst for my interest in pursuing research on an international scale. My graduate school experience was pivotal in preparing me to plan and evaluate evidence-based disease control and prevention programs, which now informs my current work abroad.

Do you have any advice for current trainees at NIAID, particularly those with an interest in epidemiology and/or public health?

Take the time to learn about research going on in other laboratories! Set up informational interviews with postdocs and PIs, and attend the many seminars offered by the different groups at NIH—even those outside of your Institute. Trust me, it’s worth it. For those with an interest in public health, I highly recommend joining the NIH Academy. The program focuses on health disparities and gaps in population health outcomes, featuring round table discussions and lectures from experts in a variety of fields, and culminates in a group community outreach project.

Our group chose to address mental health disparities in the school-to-prison pipeline—a phenomenon we likely would not have been exposed to outside the Academy. We founded Social Justice Advocacy for Incarcerated Persons (SJAIP), a multidisciplinary initiative to increase access to social and mental health resources for low-income individuals at risk or involved in the juvenile justice and adult prison system. Through local partnerships in Washington, DC, and Maryland, we launched a variety of resources including a podcast called Let's Talk Reform to continue to elevate the discussion around social and mental health needs in the school-to-prison pipeline and the justice system.

Is it okay if current NIAID fellows contact you with questions?

Of course! I am more than happy to answer questions and share my experiences with fellows interested in a career in public health. My email is nuhanaqvi@gmail.com.