Spotlight on…Judith Hahn

Judith Hahn, PhD, MA, Principal Investigator of the Uganda ARCH Cohort and Associate Professor of Medicine at the University of California San Francisco School of Medicine.

As told to URBAN ARCH Admin Core staff,  April 2014.

How did you become involved in research, in general?
From my days as a child, I was always very quantitative and liked to solve puzzles so I became a statistician. I very much enjoyed that but eventually I felt like I wasn’t getting the benefit of doing the whole puzzle. As a statistician, it often felt like I got to work on the final piece. But a larger part of the puzzle is actually thinking about the question, designing the study, even writing the grant proposal. So, I went back to school to be an epidemiologist. I really have enjoyed it because I get to concentrate on a bigger piece of the puzzle. I still do a lot of statistics but I like working through bigger the questions also. I would think “this seems to be the problem” and I see what’s been done about it in the literature and then, I think about what is missing. “Is there a knowledge gap?” It’s like writing a grant.

How did you become involved in alcohol use research?
I was always interested in HIV so I started working with a group at UCSF looking at HIV in the homeless and then, we transitioned to looking at hepatitis C virus in young injection drug users so that’s what I was working on with my mentor. I was very interested in hepatitis and I had another mentor named David Bangsberg, who was doing work in Africa. We started thinking about the fact that a lot of the people there might have hepatitis B virus. We didn’t know the prevalence of hepatitis C they had and it turns out to be very low. The people were also drinking alcohol and taking these new HIV drugs (ART) that had the potential to interact with alcohol. Originally, we were thinking that hepatitis was going to be a big issue but as we went deeper, we started thinking alcohol is really an important problem there. We found that there was very little HCV and some HBV. There wasn’t very much liver toxicity so we didn’t continue that line of research. But, we found that there were huge inconsistencies in how much alcohol use was being reported and how much use we knew was going on in the country. So there was this big puzzle in front of us, like “what’s really going on?” I think that drove my curiosity and my interest in alcohol use and alcohol reporting.

Are the methods that you are using within URBAN ARCH ones that you came up with before?
Well, we felt fairly surprised by what we were seeing by self-report so we looked for another way. By examining the literature, we found that there were several alcohol biomarkers out there. We spent several years examining some of those biomarkers because they were new and hadn’t been used in these populations. We didn’t know what they would show so we spent a lot of time looking at their characteristics before we got to URBAN ARCH.

What is the most fascinating aspect of being an epidemiologist?
It’s all fascinating! I think it’s just motivating to always have new questions. For example, when finding undetectable HIV viral loads in persons in the HIV clinic who were not yet on treatment, we wondered “what’s going on?” It’s so great that you can use the numbers and say “Oh wow, these people have been in the clinic for 6 years, what might that mean?” You can formulate the question, try to see what other people have done about it, figure out the best way to collect the data, and then hopefully, if you’ve done a great job, the data will show you the answer. That’s very exciting!

How did you first connect with the research team in Uganda?
That was through my mentor David, who established relationships there. Although, with Dr. Winnie, I went to her because she was the director of the clinic and I started asking her questions about alcohol counseling in the clinic, etc. She was so great to talk to, engaged, and so helpful that I asked her if she wanted to work together.

What are the next steps for URBAN ARCH in Uganda?
We definitely had this unique opportunity to study people prior to ART so I think this is very rare. However, ART is being started much earlier now as compared to when we started the study, so the questions will now shift to “how does alcohol affect your HIV outcomes when you are on ART?” Maybe deeper questions beyond adherence since this is already known. So our line of research will likely include more biological questions and also questions examining what we can do about it.

Are there any other important questions that need to be answered in Uganda regarding alcohol use and HIV?
We had some exciting discussions about the overlap of smoking and alcohol so I think that deserves some exploration. I think that I’m looking forward to hearing the results of the ZINC trial because if there’s something that you can do to help people who are unable to stop or reduce drinking, that’s exciting. I think that in the bigger picture, alcohol use affects HIV positives and HIV negatives. This long range thought of “can we take what we’ve learned about alcohol use and reducing alcohol use in HIV positive populations and apply that to HIV negative populations?” Those at risk for HIV are also a part of the big picture.

What do you like to do in Boston when you are in town for the URBAN ARCH annual meeting?
I like the food. I like seeing everybody. It’s incredibly stimulating to meet with everyone and exchange ideas, especially with people who are in similar fields, such as the URBAN ARCH steering committee and the advisory panel. Last year, a lot of people came. And, I like to see my sister and her family.

But you have so much good food in San Francisco!
What we don’t have is what you have in the North End –real Italian food. We have Italian food but this is really amazing!

Tell us one surprising thing about yourself.
I like to play tennis. I’m a homebody. I like to stay home and sit at my back porch. I like to snowboard a bit.

Do you have any other information you’d like to include in this interview?
I think that this has been a really great (and I hope will continue to be a great) collaboration. Sometimes, it is challenging with the time zones but I think everyone is OK with that and works around it. It’s exciting to have the international Cohorts and see how different they are. It would be interesting to see if biologically, they have similarities, and how the cultural differences play into the important issues.