Students Who Rocked Public Health 2019: Christina Chandra

Last December, Christina Chandra, an MPH student in Global Epidemiology at the Rollins School of Public Health, Emory University, was listed as one of 13 Students Who Rocked Public Health in 2019 for her work surveying and interviewing HIV care providers on mental health services integration for adults living with HIV in Bangkok, Thailand. Follow along each month as we profile all 13 Students Who Rocked Public Health 2019.

As part of my MPH “Applied Practice Experience” during the summer of 2019, I worked closely with TREAT Asia/amfAR, The Foundation for AIDS Research to assess the barriers and facilitators to integrating mental health services in HIV care settings in Bangkok, Thailand. There are nearly half a million people living with HIV in Thailand, and studies have found that HIV-related stigma is associated with depression among Thai people living with HIV. They may also experience stigma and discrimination related to drug use, sex work, or having same-sex partners that may further impact their mental health. Mental health problems have been associated with poorer health outcomes for Thai people living with HIV. Meanwhile, Thailand has a shortage of mental health workers (14 per 100,000 persons), so the integration of basic, high-quality mental health services in HIV care is one approach to address mental health problems in this population.

First day of work with my research mentors (from left to right: Dr. Annette Sohn, VP and Director; Tor Petersen, Project Manager; Dr. Jeremy Ross, Director of Research).

As part of my project, I conducted key informant interviews and an online survey of HIV care providers to understand whether providers already conducted mental health screening, diagnosis, or treatment, and barriers and facilitators to providing mental health care. Participants included community health workers, counselors, nurses, peer educators, and physicians. To get this project off the ground, I applied for funding from Emory for me to pursue this work in Bangkok, designed the study, submitted it for IRB approval, developed the data collection tools, recruited participants, analyzed the data, and shared the results with clinics who participated in the study and other key stakeholders.

We found that many HIV providers were screening for mental health problems like depression, anxiety, and substance use but not really diagnosing and treating mental health problems. Patients who screened positive for severe mental health problems were often referred to a specialist for diagnosis and treatment. Providers noted that referrals may be a concern if mental health problems worsened before the individual’s appointment or if they did not go to their scheduled appointment. Most providers noted that they would like more training on providing mental health care.

My parents immigrated to the US from Indonesia, and most of my relatives still live in the Asia-Pacific region today. As such, I was motivated to pursue a project in Southeast Asia if I could find a research opportunity in HIV. I previously worked for amfAR as an Allan Rosenfield Public Policy Fellow in 2016, and one of my former colleagues connected me with my supervisors in Bangkok. After a couple of Skype calls discussing potential project ideas, I moved forward with pursuing the opportunity and applied for funding.

Dr. Pim Brouwers (Deputy Director of the Office of AIDS Research at the National Institute of Mental Health; second from right) visited the office and listened to research presentations from myself and Dr. Tavitya (second from left) about mental health services for people living with HIV in Thailand.

For other students currently considering summer research or internship opportunities, I recommend trying something new in a topic area that you are passionate about. The summer is a great opportunity to develop new skills to add to your resume and expand your network. Additionally, a good mentor can make all the difference in how you feel about your experience. Good mentors may give you important feedback on your work, be invested in your success during the summer and beyond, and care about your holistic experience working for them (eg, adjusting to a new setting). Because of the great mentorship I received, I was able to attend a conference in Hong Kong and collaborate with other HIV researchers on a separate project related to mental health and HIV among adolescents. By the end of the summer, I would hope that you have a better sense of the type of work you do or do not want to pursue in public health and that you have built relationships that will be influential in your career.

My experience with TREAT Asia/amfAR further solidified my motivation to pursue a PhD in Epidemiology, which I will begin in the Fall. I enjoyed having the responsibilities of leading a research project from beginning to end – from the development of the research question, study design, creation of data collection tools, data analysis, to the dissemination of results. I am especially grateful to my field advisors, Drs. Annette Sohn and Jeremy Ross, for their guidance on the project and the TREAT Asia staff who provided invaluable support on the project, from helping to revise and translate the survey to helping to recruit participants.

Read About More Students Who Rock:

Author Profile

Christina Chandra
Christina Chandra is a second-year MPH student in Global Epidemiology at the Rollins School of Public Health, Emory University. She has a BA in History of Science, Medicine, and Public Health from Yale University. Her research interests are in HIV prevention, and the intersection of HIV and mental health and aging. Follow her on Twitter or LinkedIn.