Research

Marked global disparity in cancer burden exists with about 90% of all cancer deaths occurring in low- and middle-income countries. For cervical cancer, sub-Saharan Africa experiences the highest incidence and mortality of any world region. Sometimes referred to as a preventable cancer, cervical cancer and pre-malignant cervical lesions can be easily identified through screening with multiple screening modalities available. Still, in countries like Ethiopia, less than 10% of women have ever been screened in their lifetime.

I study women’s and health providers’ perspectives of cancer and knowledge of cancer signs, symptoms, and risk factors. My research also aims to document perceived barriers to implementation of screening programs and facilitators that have proven effective for improved implementation. This work lays the groundwork for more advanced understanding of the health system, cancer control policies and programs, interventions for improved screening and treatment, and ultimately more favorable patient outcomes.

I am currently conducting one year of postdoctoral field work in Ethiopia as a Global Health Equity Scholar. The GHES program is one of six signature N.I.H. Fogarty Global Health Programs for Fellows and Scholars (D43TW010540) and is administered by a consortium of universities including The University of California Berkeley, Stanford, Yale, and The University of Arizona. My project titled "Cervical Cancer Screening Uptake and Preferences of Ethiopian Women by HIV Status: Comparing Community- vs. Facility-Based Practices" was selected by the National Cancer Institute to be co-funded with Fogarty International Center. In addition to conducting independent research, I have received N.I.H. training in qualitative methods and special topics such as decolonization of global health.

Beyond cervical cancer screening, I have a budding interest in other global cancer issues and plan to expand my research to include other types of cancer such as breast cancer and those of significance to underserved global majority populations, implementation science studies of prevention, treatment, and referral pathways, and survivorship and quality of life.

Lott, B.E., Trejo, M.,J., Baum, C., McClelland J., Adsul, P., Madhivanan, P., Carvajal, S., Ernst, K., & Ehiri, J. (2020). Interventions to increase uptake of cervical screening in sub-Saharan Africa: A scoping review using the Integrated Behavioral Model. BMC Public Health, 20:654. https://doi.org/10.1186/s12889-020-08777-4. 

Lott, B.E., Halkiyo, A.B., Worku D., Kebede, T., Dedefo, A., Madhivanan, P., Carvajal, S., Ehiri, J., Soliman, A. (2021). Health workers’ perspectives on cervical cancer screening in Ethiopia: Barriers and facilitators to a implementing a new national screening program. BMC Women’s Health, 21(1), 1-14. https://doi.org/10.1186/s12905-021-01331-3

Adsul, P., Hariprasad, R., Lott, B.E., & Varon, M.L. (2022). Advancing the Science of Implementation for Resource-Limited Settings through Bidirectional Learning Around Cervical Cancer Screening. Ethnicity & disease, 32(4), 269.

Baum, C., Soliman, A.S., Hablas, A., Seifeldin, I.A., Ramadan, M., Nguyen, A., Lott, B.E., Brown, H.E. (2020). Regional variation of pancreatic cancer in the Nile delta region of Egypt. Journal of Cancer Epidemiology. https://doi.org/10.1155/2020/6031708. 

In addition to global cancer disparities, I am interested in cancer inequity in high-income settings as well. In the United States, for example, certain groups are at an increased risk for cancer and experience worse cancer outcomes. One review that I authored systematically evaluated HPV vaccination interventions targeted to racial/ethnic and sexual and gender minority groups. 

Lott, B.E.,  Kram, N., Okusanya, B., Anderson, E., Rodriguez, M., Thomson, C., Harris, R., Ehiri, J., McLelland, J. & Rosales, C. (2020). Interventions to increase Human Papillomavirus (HPV) vaccination uptake among minority populations: A systematic review. Preventive Medicine Reports, 101163. https://doi.org/10.1016/j.pmedr.2020.101163.

Global health efforts to halt HIV over the last several decades have been profound. As antiretroviral treatment has been developed and made widely available, people living with HIV (PLWHIV) have increasingly lived long, healthy lives. As life expectancies have increased, comorbidities have become of increasing concern for this population. Women living with HIV are of particular importance to any cervical cancer prevention efforts, due to their increased risk for disease development. As cancer control efforts are adapted for sub-Saharan African contexts, integration with the HIV care system is vital. For this reason, HIV is a central theme of much of my global cancer research.

Additionally, I have studied task-shifting policies for more efficient and responsive HIV care delivery and HIV/AIDS stigmatization in health care settings to better understand barriers to care for pregnant women in Nigeria. As a Peace Corps Health Specialist in Ethiopia, I worked with a local town health administration office and PLWHIV associations to deliver HIV prevention education. 

Kram, N.A.Z., Yesufu, V., Lott, B.E., Palmer, K.N.B., Balogun, M., & Ehiri, J.E. (2021) 'Making the most of our situation': a qualitative study reporting health providers' perspectives on the challenges of implementing the prevention of mother to child transmission of HIV services in Lagos, Nigeria. BMJ Open; 11(10): e046263. https://doi: 10.1136/bmjopen-2020-046263

Ehiri, J., Alaofe, H., Victoria, Y., Balogun, M., Iwelunmor, J., Obosede, O., Kram, N., & Lott, B.E. (2019).  AIDS-Related stigmatization in the healthcare setting: a study of primary healthcare centers that provide services for prevention of mother-to-child transmission of HIV in Lagos, Nigeria. BMJ Open, 9(5): e026322. http://dx.doi.org/10.1136/bmjopen-2018-026322. 

In both high-income and low- and middle-income country contexts, another theme of my research is interprofessional collaboration and health systems strengthening. This work has looked at relational coordination between offices of a large local health department, collaborative practice agreements between pharmacists and other clinicians, and patient care processes that foster collaboration and continuum of care.

Lott, B.E., Anderson, E.J., Villa Zapata, L., Taylor, A.M., Cooley, J., Forbes, S., Warholak, T. (2020). Pharmacists’ perceptions of the Pharmacists’ Patient Care Process and performance in a simulated patient activity. Journal of the American Pharmacists Association. https://doi.org/10.1016/j.japh.2020.03.017

Lott, B.E., Anderson, E.J., Villa Zapata, L., Taylor, A.M., Cooley, J., Forbes, S., Warholak, T. (2020). Expanding pharmacists’ roles: Pharmacists’ perspectives on barriers and facilitators to collaborative practice. Journal of the American Pharmacists’ Association. https://doi.org/10.1016/j.japh.2020.11.024

McCullough, J.M., Eisen-Cohen, E., & Lott, B. (2018). Barriers and facilitators to intraorganizational collaboration in public health: Relational Coordination across public health services targeting individuals and populations. Health Care Management Review, 45(1):60-72. DOI: 10.1097/HMR.0000000000000203. 

Lastly, broad interests in global maternal and child health have led to involvement in a range of other health research projects such as a Save The Children study on infant diarrhea and associated water, sanitation and hygiene practices in rural households in Ethiopia and a review of emergency transportation interventions to improve pregnancy outcomes in sub-Saharan Africa.

Alaofe, H., Lott, B., Kimaru, L., Okusanya, B., Okechukwu, A., Chebet, J., Meremikwu, M., & Ehiri, J. (2020). Emergency transportation interventions for reducing adverse pregnancy outcomes in low- and middle-income countries: A systematic review. Annals of Global Health, 86(1), 147. https://doi.org/10.5334/aogh.2934

Water, Sanitation, and Hygiene in Rural Households in Amhara, Oromia, SNNP, and Tigray: A Report on Findings and Recommendations from a Multi-Method Qualitative Research Study for Social and Behavior Change Communication Programming in Ethiopia. (2014).  Save The Children, Ethiopia. Available at: https://ethiopia.savethechildren.net/sites/ethiopia.savethechildren.net/files/WASH%20Lo%20Res.pdf.