In a recent perspective published by the New England Journal of Medicine (NEJM), Stanford Law student Alexandra Daniels analyzed a growing body of federal litigation brought by prisoners with the hepatitis C virus (HCV) who are seeking access to treatment for their condition. With co-author and mentor, Law Professor David Studdert — also a professor of medicine at Stanford Health Policy — Daniels documented the dire public health problem of HCV in prisons.

“People incarcerated in prisons account for approximately one third of HCV cases in the United States” the authors wrote, and nearly one in five prisoners are infected, compared with 1 percent of the general population. 

HCV is a slow-moving disease, but left untreated it eventually leads to cirrhosis, cancer, liver failure, and death.  

A new wave of “miracle” drugs for treating HCV appeared in 2014. Direct-acting antivirals–or DAAs–are far more effective than anything previously known. The catch–they are extremely expensive, upwards of $50,000 for a course of treatment.  This creates a far higher price tag for universal treatment than most prison systems can afford. The result is that, even though prisons are the epicenter of the HCV epidemic, only a small minority of prisoners have gained access to DAAs.

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Stanford postdoc Ashley Styczynski was working on newborn antimicrobial resistance in Bangladesh when the pandemic hit. The infectious disease physician realized she had to switch gears and began working with the ministry of health to prepare hospitals for the onslaught of COVID-19 patients.

“During my trainings on infection control in Bangladeshi hospitals, I learned that many health-care workers were paralyzed by the fear of not knowing how to protect themselves against COVID-19 while caring for patients, especially during shortages of PPE,” she said. “I think this has substantially contributed to the large number of health-care workers becoming infected during the pandemic. In fact, Bangladesh has the highest rate of physician mortality from COVID of any country.”

So Styczynski turned to her Stanford colleagues back home and proposed a set of infographics that could help health-care workers in Bangladesh and other under-resourced countries. Armed with a seed grant from the Stanford Center for Innovation in Global Health, they have established a website devoted to the creation and use of personal protective equipment (PPE). Bangladesh Ministry of Health has adopted their guidelines and Styczynski hopes other health ministries will do the same.

“I want them to be a tool to empower health-care workers — not just in Bangladesh but also in other low- and middle-income countries — to protect themselves with whatever resources they have access to,” Styczynski said. She said the team of collaborators from Stanford grew when researchers from other institutions heard about the research and wanted to get involved.

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The website also includes a video on PPE donning-and-doffing techniques, illustrations for building ultraviolet germicidal irradiation (UVGI) cabinets to decontaminate masks, and the PPE infographics in other languages.

Stephen P. Luby, MD, a core faculty member at Stanford Health Policy and senior fellow at the Freeman Spogli Institute for International Studies and the Woods Institute for the Environment, said the project grew out of Styczynski’s background in infectious disease epidemiology and her deep engagement with collaborators in Bangladesh.

“These scientifically sound, easy-to-understand visuals provide a clear example of how deep engagement in a high-need context allows Stanford researchers to make contributions that impact lives globally,” Luby said.