Esther E. Freeman’s research while affiliated with Massachusetts General Hospital and other places

What is this page?


This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.

Publications (128)


Rethinking neglected tropical diseases: A shift towards more inclusive and equitable terminology
  • Article
  • Full-text available

February 2025

·

50 Reads

Marlous L. Grijsen

·

·

Al Kadri

·

[...]

·

Neglected tropical diseases (NTD) refer to a group of 21 diseases that disproportionally affect impoverished communities in low- and middle-income countries (LMIC) [1]. NTD collectively impact 1.7 billion people, which is about 20% of the world’s population [1]. Each year, NTD account for more than 200,000 deaths, with millions left disabled and disfigured due to insufficient access to care and affordable treatment, often leading to social exclusion, stigmatization and discrimination. Although the term NTD has successfully directed funding and resources towards these conditions and encouraged global partnerships and high-level policy initiatives, the term may also have unintended negative consequences. In this paper, we aim to explore the term NTD and stimulate a dialogue that re-evaluates its meaning into more inclusive and equitable language.

Download


Emerging Challenges in Global Health Dermatology: measuring impact and sustainability

November 2024

·

24 Reads

British Journal of Dermatology

As initiatives addressing health inequity rise in dermatology there is growing interest among funders and nonprofits in defining and measuring two key aspects of global health success: impact and sustainability. Demands to clearly describe and demonstrate both impact and sustainability in global health dermatology and health equity programs from funders are to ensure accountability, proper use of funds, and mutually beneficial outcomes. There is no one-size-fits-all method for evaluating health interventions. Instead, we highlight approaches that can be tailored to specific global health efforts to better conceptualize both areas to improve operational strategies and their implementation internally and communication with funders externally.


Photos of the smartphone colposcope and SCME device used in clinic (A, B) and a representative smartphone colposcopy image showing SCME placed on the cervix (C)
Representative SCME images (A, D) and their manually-segmented images (B, E) and automatically-segmented images (C, F) for an image with low cell density (A, B, C) and high cell density (D, E, F)
Study flow diagram. *We invited all women who were interested to consent for the study, and gave them the option to withdraw from the study at any time. All the women accepted to participate and gave written consent. However, one woman later declined to have a speculum exam and did not continue with the subsequent study procedures
Representative confocal endoscopy (A-D), histologic (E, F), and smartphone colposcopic (G, H) of benign (A, C,E, G) and HSIL (B, D,F, H) tissues
Morphometric parameters of cell nuclei visualized in confocal images of benign/LSIL and HSIL tissues
Usability of a smartphone-compatible, confocal micro-endoscope for cervical cancer screening in resource-limited settings

September 2024

·

49 Reads

Background More efficient methods to detect and treat precancerous lesions of the cervix at a single visit, such as low-cost confocal microscopy, could improve early diagnosis and hence outcomes. We piloted a prototype smartphone-compatible confocal micro-endoscope (SCME) among women presenting to a public cervical cancer screening clinic in Kampala, Uganda. We describe the piloting of the SCME device at an urban clinic used by lower cadre staff. Methods We screened women aged 18 and 60 years, who presented for cervical cancer screening at the Kawempe National Referral Hospital Kampala, and evaluated the experience of their providers (nurses). Nurses received a 2-day training by the study doctors on how to use the SCME, which was added to the standard Visual Inspection with Acetic acid (VIA)-based cervical cancer screening. The SCME was used to take colposcopy images before and after VIA at positions 12 and 6 O’clock if VIA negative, and on precancer-suspicious lesions if VIA positive. We used questionnaires to assess the women’s experiences after screening, and the experience of the nurses who operated the SCME. Results Between November 2021 and July 2022, we screened 291 women with a median age of 36 years and 65.7% were HIV positive. Of the women screened, 146 were eligible for VIA, 123 were screened with the SCME, and we obtained confocal images from 103 women. Of those screened with the SCME, 60% found it comfortable and 81% were willing to screen again with it. Confocal images from 79% of the women showed distinguishable cellular features, while images from the remaining 21% were challenging to analyze. Nurses reported a mean score of 85% regarding the SCME’s usefulness to their work, 71% regarding their satisfaction and willingness to use it again, 63% in terms of ease of use, and 57% concerning the ease of learning how to operate the SCME. Conclusion Our findings demonstrate the feasibility of using the SCME by lower cadre staff in low-resource settings to aid diagnosis of precancerous lesions. However, more work is needed to make it easier for providers to learn how to operate the SCME and capture high-quality confocal images.



Figure 3. Cumulative incidence of death, as determined by the Kaplan-Meier estimator, following diagnosis of KS among adults living with HIV with newly diagnosed Kaposi sarcoma between 2016 and 2019 at one of three health systems in Kenya and Uganda. The shaded area represents the 95% confidence interval around the cumulative incidence estimate. Panel A depicts the base-case analysis in which participants who became lost to follow-up were censored on the last date they were known to be alive. Panel B depicts a sensitivity analysis in which participants who became lost to follow-up were classified as dead the day after they were last known to be alive ("worst case" mortality). Panel C depicts a sensitivity analysis in which participants who became lost to follow-up were classified as alive as of the date of administrative censoring for the study population ("best case" survival).
Survival Following Diagnosis of HIV-Associated Kaposi Sarcoma Among Adults in East Africa in the Treat-All Era

August 2024

·

30 Reads

Background: Despite widespread access to antiretroviral therapy (ART) in the Treat All era, HIV-associated Kaposi sarcoma (KS) remains among the most common malignancies in sub-Saharan Africa. Survival after KS diagnosis has historically been poor in Africa, but knowledge whether survival has changed at the population level in the contemporary era has been limited by lack of community-representative surveillance and monitoring systems. Methods: We identified all adult persons living with HIV (PLWH) with a new diagnosis of KS made between 2016 and 2019 during outpatient or inpatient care at prototypical primary care-providing medical facilities in Kenya and Uganda using rapid case ascertainment. Participants were subsequently followed for vital status, including community tracking for those who became lost to follow-up. Findings: Among 411 participants with newly diagnosed KS, 71% were men, median age was 34 (IQR: 30 to 41) years, and 91% had ACTG T1 tumor extent. Over a median follow-up of 7.8 (IQR: 2.4 to 17.9) months, cumulative incidence of death (95% CI) at months 6, 12 and 18 were 34% (30% to 39%), 41% (36% to 46%) and 45% (40% to 51%), respectively. Having the highest number of anatomic sites (11 to 16) harboring KS lesions (hazard ratio 2.2 (95% CI: 1.3-3.8) compared to 1 to 3 sites) and presence of oral KS lesions (hazard ratio 2.2 (95% CI: 1.4-3.3)) were independently associated with higher mortality. Lower hemoglobin and CD4 count as well as higher plasma HIV RNA were also associated with higher mortality. Interpretation: Among PLWH with newly diagnosed KS in East Africa in the Treat All era, survival was poor and related to mucocutaneous extent of KS. The findings emphasize the need for better control of KS in Africa, including novel approaches for earlier detection, better linkage to oncologic care, and more potent therapy.



Expanding global health dermatology leadership: launching the GLODERM international mentorship program

April 2024

·

38 Reads

·

1 Citation

British Journal of Dermatology

Lack of access to dermatologic care is a global health crisis. Providing intentional mentorship to emerging leaders in low and middle income countries is foundational to increasing access to care.The GLODERM mentorship program is a first of its kind program created to support changemakers in global health dermatology in enhancement of leadership skills.


Impact of a multicomponent navigation strategy on stigma among people living with HIV and Kaposi’s Sarcoma in Kenya: a qualitative analysis

April 2024

·

35 Reads

·

1 Citation

JNCI Monographs

Persons with HIV-associated Kaposi’s sarcoma (KS) experience three co-existing stigmatizing health conditions: skin disease, HIV, and cancer, which contribute to a complex experience of stigmatization and to delays in diagnosis and treatment. Despite the importance of stigma among these patients, there are few proven stigma-reduction strategies for HIV-associated malignancies. Using qualitative methods, we explore how people with HIV-associated KS in western Kenya between August 2022 and 2023 describe changes in their stigma experience after participation in a multicomponent navigation strategy, which included 1) physical navigation and care coordination, 2) video-based education with motivational survivor stories, 3) travel stipend, 4) health insurance enrollment assistance, 5) health insurance stipend, and 6) peer mentorship. A purposive sample of persons at different stages of chemotherapy treatment were invited to participate. Participants described how a multicomponent navigation strategy contributed to increased knowledge and awareness, a sense of belonging, hope to survive, encouragement, and social support, which served as stigma mitigators, likely counteracting the major drivers of intersectional stigma in HIV-associated KS.



Citations (61)


... As reflected in "Skin and DigitaleThe 2024 Narrative" (du Crest et al, 2024), the field of dermatology is undergoing significant transformation. The collaborative efforts between the SDS, Magic Wand Initiative, and New Ideas for Medicine, initiated in 2022, have laid a strong foundation for digital transformation and innovation in clinical dermatology, esthetics, and skincare. ...

Reference:

Skin & Digital – The 2023 Startups / Innovators
Skin & Digital – the 2024 Narrative

Mayo Clinic Proceedings Digital Health

... Topical therapies serve as the cornerstone of acne management and can be utilized both for initial treatment and maintenance, either as monotherapy (excluding topical antibiotics) or in combination with other topical or systemic agents. Frequently employed topical treatments include retinoids, benzoyl peroxide, antibiotics, clascoterone, salicylic acid, and azelaic acid [10]. ...

Guidelines of care for the management of acne vulgaris
  • Citing Article
  • January 2024

Journal of the American Academy of Dermatology

... This is especially relevant as most people in the US and Canada have received a primary series of an mRNA vaccine. Concern about side effects is a primary reason for COVID-19 vaccine hesitancy [22][23][24]. Accordingly, COVID-19 vaccines with lower rates of reactogenicity, which is suggested of heterologous use of NVX-CoV2373 by the present analysis and several descriptive studies [12,25,26,30], have the potential to decrease vaccine hesitancy. This may be especially useful given the continued evolution of SARS-CoV-2 and recommendations from public health authorities for annual updates to the COVID-19 vaccine strain composition [32][33][34][35], suggesting the potential need for a seasonal COVID-19 vaccination, similar to influenza vaccination. ...

The Impact of Coronavirus Disease 2019 (COVID-19) Vaccine Reactions on Secondary Vaccine Hesitancy
  • Citing Article
  • January 2024

Annals of Allergy Asthma & Immunology

... The first is the disproportionate frequency of diagnosis among PWH, likely because of immunologic risk and transmission through sexual networks, and high rates of other sexually transmitted infections (STIs) [3,4]. In 2023, fulminant, or necrotizing mpox, was proposed as an acquired immunodeficiency syndrome (AIDS)-defining condition [5]; more severe disease and complications have been documented amongst series of PWH with low CD4 T-cell count and without HIV virologic suppression [6][7][8]. However, because most evaluations of mpox in PWH have compared the experience of mpox in PWH to people without HIV, there are gaps in understanding clinical correlates of risk and protection among PWH, including the impact of treatment and vaccination on outcomes in this population. ...

HIV and mpox: Evaluation of clinical course and outcomes from an international dermatologic registry
  • Citing Article
  • December 2023

Journal of the American Academy of Dermatology

... Building upon the work by Albucker et al. and Moseley et al. [15], our findings highlight challenging real-world scenarios in managing onychomycosis patients where this chronic condition is often seen in conjunction with other co-morbid illnesses, for example, diabetes. Furthermore, in view of a growing recognition of healthcare inequities [19,20], we identified potential disparities in access to care for the management of onychomycosis-especially concerning minority groups and low-income individuals who are at a higher risk-where the ordering of diagnostic testing and prescribing of treatments were linked to socioeconomic factors. ...

Global health dermatology: An emerging field addressing the access to care crisis
  • Citing Article
  • December 2023

Indian Journal of Dermatology Venereology and Leprology

... this approach encompasses raising awareness of trafficking risks, developing targeted interventions for vulnerable populations, strengthening legal frameworks, providing support to potential victims, addressing root causes such as poverty and social inequality, promoting international cooperation, and implementing educational programs that enhance individual and community resilience in the face of trafficking networks (Mak et al., 2023;McDow & Dols, 2021;olivieri et al., 2024). the obligation to combat human trafficking falls on the state as a whole (Pollock et al., 2024). to achieve an effective fight with tangible and measurable results, the active articulation and participation of multiple government agencies is necessary (Konrad et al., 2017;turvey & coronado, 2023). ...

Dermatology’s Role in the Fight Against Human Trafficking: A Report from the AAD Ad Hoc Task Force and Call to Action
  • Citing Article
  • October 2023

Journal of the American Academy of Dermatology

... Typically, in mpox, skin changes are accompanied by local lymphadenopathy [6]. In most patients, the distribution of skin lesions corresponds to the site of MPXV inoculation [8]. Given that the current outbreak primarily impacted men who have sex with men (MSM), the rash was frequently noted in the anogenital area [9]. ...

533 Mpox first skin lesion location: A reflection of mode of transmission?
  • Citing Article
  • May 2023

Journal of Investigative Dermatology

... The International League of Dermatological Societies (ILDS), in collaboration with the American Academy of Dermatology (AAD), has meticulously documented a compendium of 2500 instances emanating from diverse regions, totaling up to 72 countries [36]. Predominant dermatological manifestations correlated with COVID-19 were identified. ...

The impact of the American Academy of Dermatology/International League of Dermatological Societies COVID-19 Registry during the pandemic: 2500 cases across 72 countries
  • Citing Article
  • April 2023

Journal of the American Academy of Dermatology

... Since publication of the consensus recommendations, six journals have adopted the proposed reflexivity statement, with varying degrees of adaption, including BMJ Global Health, Anaesthesia, Lancet Global Health, Medical and Veterinary Entomology, Wellcome Open Research and British Journal of Dermatology. [3][4][5][6][7][8] A further journal, Global Health Science and Practice, and also PLoS and Cell Press-two major scientific publishers, each with a suite of journals in their stable-have developed their own questionnaire format for authorship reflexivity. [9][10][11] However, in the early stages of implementation, we recognise that producing reflexivity statements may not always be straightforward for author teams. ...

The BJD's approach to global health and equity in publishing: adding author reflexivity statements

British Journal of Dermatology

... The International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium collects de-identified routine clinical data from over 2.2 million people living with and at risk for HIV enrolled in participating HIV treatment and care sites in 44 countries across seven geographic regions: the Asia-Pacific; the Caribbean, Central and South America (Latin America); Central Africa; East Africa; Southern Africa; West Africa; and North America [20][21][22]. In addition to collecting routine patient-level data, IeDEA conducts periodic cross-sectional site assessment surveys among participating clinics to better understand and assess clinic characteristics, current clinical practices and support services available to enrolled PLHIV [23]. ...

Design and implementation of a global site assessment survey among HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium