Dr. Anna Hotton is a Staff Scientist in the Section of Infectious Diseases and Global Health. She is also the Director of Epidemiology of the Chicago Center for HIV Elimination (CCHE). Dr. Hotton’s research focuses on the impact of socio-structural stressors on HIV/STI risk and patterns of care engagement. She received her MPH and PhD in epidemiology from the University of Illinois at Chicago School of Public Health. We look forward to her direction and insight to our research projects.
The transcript (edited for clarity) can be found below.
Introduction
Simatul Rashid (SR): Before delving into your experience working at the CCHE, I would love to learn a little bit about yourself. Where are you from? Where did you go to college? What did you study, etc?
Anna Hotton (AH): I grew up in upstate NY. I went to college in Ithaca, NY in Cornell. I spent all my growing up years in upstate New York. I studied biology as an undergrad. The official major was called Human Biology Health and Society. I think in hindsight it ended up being a good introduction for public health because it was a flexible major that offered a broad view of health outcomes from different perspectives. You got to take basic biology, science and math courses. You were also able to take classes in sociology so I got exposure to a lot of the types of thing that have eventually come back to be important in my work in public health.
SR: Would you be able to tell me a little bit about how you became interested in epidemiology?
AH: I don’t think I learned about epidemiology as an undergrad. I sort of discovered it after college. I don’t remember exactly how I first learned of it. I think a friend of a friend suggested that public health could be a good field to get into. I was thinking about what I wanted to do. I considered pursuing a medical degree but I decided that wasn’t quite right for me. I was looking into other options and based on his recommendation, I started looking at public health graduate programs and learning about epidemiology & biostatics. I thought epidemiology could be a good fit because it offered the opportunity to apply statistics, learn health statistics, understand disease etiologies, things that could go well with my background and could be interesting. I still wasn’t sure what I could do but I saw myself doing research, and I was looking for something that would let me do quantitative work which I liked. I liked math and statistics. This seemed like a nice way to do work that could be meaningful and impactful, so I thought it seemed appealing. That was how I applied to public health and got involved in the field.
SR: Do you think grad school solidified your choice in this career rather than undergrad?
AH: I think so. I think the grad school experience was more focused which is common because you specialize at that point. But I think if anything, I would have liked to have a more interdisciplinary focus in grad school. But because of the nature of the coursework, it was a little bit more regimented in terms of the types of courses that I took. I didn’t do as much of the social science type work as formal coursework. But I encountered it more as I started working in the field more so that background came in.
SR: The faculty description page lists that you are interested in studying how structural barriers impact HIV related outcomes among diverse groups. Do you think these structural barriers are the result of any sort of disparities based on socioeconomic or racial factors faced by these groups?
AH: Yeah so that’s an important point. I think they definitely result from multiple systems of oppression whether through racism, homophobia or transphobia. They are all intersecting. People have multiple intersecting identities that shape how they are and how they engage with services. So I think these things have widespread consequences that manifest in an individual level in terms of socioeconomic status, education and employment opportunities, health outcomes and healthcare engagement. I think that in medicine and epidemiology we are trained to focus on individual factors that impact individual health outcomes. That’s important. This is how ultimately diseases are transmitted. It’s important to understand how things are occurring allowing us to learn distal factors that influence people’s downstream behavior and health outcomes. So, of course, helping the individual navigate within these systems is important. Another thing that is important is bringing more strength-based approaches and trying to think about how to make people capitalize on strengths and navigate through this system that are impacting their lives.
SR: Do you see yourself helping communities or do you think you want to impact more on the individual level?
AH:I consider myself as a social epidemiologist. I am interested in how factors in multiple levels impact population-level health outcomes. For the intervention and the communities, we are working with, we can have interventions in multiple levels so we do need intervention to help individuals and to help communities. We do need to think of it as a larger system than individuals.
SR: Did you ever consider any other careers in public health after entering the field and getting exposed to all the different intersections of public health?
AH: I don’t know that I considered paths other than epidemiology. I sort of saw this as a good fit for me. Having worked in different settings, I definitely got different perspectives about the challenges of both doing research and HIV prevention work. I worked at community based organization and academia. I think it gave me an appreciation for the different challenges that go into this work. It has allowed me to see the importance of building interdisciplinary collaboration and meaningful partnerships between academic organization and communities so that research findings can be translated into meaningful outcomes for people. Given my background and training, I liked the methodological work and sort of challenging methodological questions. I really liked the applied aspect of the work. I think it’s important to use research for advocacy and try to do as much as we can to promote high quality translational research that’s beneficial to communities
SR: For me, one of the reasons that I am pursuing medicine is because you can directly see the impact you are making in the community while research can seem a bit more far removed from the community. Do you feel like sometimes your research doesn’t get dispersed to the community?
AH: Personally I struggle with that. I do think part of it often is that the findings aren’t getting translated in a meaningful way. When there are academic institutions and research that’s not directly driven or aligned with the goals of a community organization or people working in the field, it creates challenges in translating the findings in a meaningful way. We need to do better on multiple fronts, both in terms of working with the community and building those partnerships. But, also communicating the findings in a more deliberate and thoughtful way so that it can be useful. Sometimes everybody is doing a lot. It doesn’t happen in an ideal way.
SR: I agree. Academic institutions have a responsibility to disperse research findings to the disadvantaged communities they research upon.
Road to CCHE
SR: I would love to know about how you got involved with CCHE.
AH: I had known about CCHE in a while by working in the field. I was interested in the work because of the model and holistic approach to prevention, care, and integrated service of research. I like that approach and that CCHE helps translate research into practice directly. The network modeling was interesting. A lot of aspects was interesting. For example, the computational modeling program that they have been building up was interesting as well using computer simulations to test different intervention practices. That was interesting to me in a methodological perspective. I was interested in whether computer modeling could be used in an epidemiological way to understand disease mechanism and test intervention. I think that it hasn’t been used extensively in social epidemiology so I thought there could be an expansion of that. So when the opportunity became available, I was excited because it was well aligned with my research experience, goals, and offered need-based innovative work.
SR: Do you think working at CCHE has swayed you from your previous interests? Have you been involved with HIV related work before?
AH: I had been primarily doing HIV related work. I don’t know that it necessarily swayed my interest. It has expanded perspective on certain things. I think it offered opportunities to build on stuff I was doing such as using simulations and modeling in innovative ways to answer questions. I think there are potentially exciting methodological and substantive areas that could be expanded that I have sort of thought about in the past but never had the opportunity to work in the past. CCHE offers a lot of that. That’s exciting for the future. I have been here for about 9 months I feel like there a lot of opportunities for the future to learn and grow.
SR: Have you been involved with anything other than HIV?
AH: Most of my research has been HIV or STI related. I did work around Hepatitis C transmission. I have been involved in a Hepatitis modeling project with UIC that is centered around Hepatitis C elimination. It’s a collaboration between our group and UIC. I have focused on infectious diseases generally in various population. A lot of that has been HIV focus.
SR: How much of an impact do you think CCHE has made on your life, and do you think you have made a substantial impact on the people you have been working with through CCHE?
AH: I don’t know how much I have done because I haven’t been working here for that long. I hope to make impacts through doing the research and trying to be thoughtful about the questions we are asking, working with community members, and getting feedback. I hope to contribute to that in the future. I hope to do research that can be translated into service to improve service provisions. To contribute to intervention work that’s beneficial to people.
SR: Do you like the work environment at CCHE?
AH: I really like the teamwork approach here. I have done a lot of collaborative team science type work, partly because of my methodological background I do a lot of analytical and methodological work. I like the teamwork approach because its beneficial to providing new perspectives and thinking outside of the box. I think it contributes to good science. I like the integration of service and research here. I hope to continue to contribute to that.
SR: Your work at CCHE involves risk evaluations, engagement, and retention in care. Do you think all these factors in conjunction are equally influential in instilling preventative measure? Or do you think one takes precedence over the other?
AH: Well I think they are all important. We need multifaceted approaches. You know as much as we can take a broad view of things, I think it’s good meet people and help them reduce risk and figuring out what’s working best for people. It goes back on what I was saying about individual levels. People’s circumstances are so fluid so there isn’t one single approach that’s going to be the best for everyone but we should aim to approach it in a more nuanced way. Now that we have PREP and prevention approaches that are important. It’s important to keep people in care and making sure PREP is accessible to people who need it the most. I think those are important. Combining them is easier said than done given the additional challenges people face. We should think about it in terms of what other barriers do we need to help address. What do we need to do that that involves addressing social structural barriers as well as just whatever we can do? I think it takes a multifaceted approach.
SR: Is there a project you are really excited about currently?
AH: I am working on several computational modeling projects here. They are focused on stimulating the effects of interventions to increase PREP and ART uptake. I am interested in applying these to other intervention approaches, maybe social and structural intervention. That has been challenging and exciting. It’s sort of a newer area. I have been involved in a little bit of modeling work but my background isn’t in modeling. I have been learning a lot which I like but it has been challenging. I think that offers a lot of opportunities to think about interventions in new ways. I think it’s important in thinking about interventions and just as a tool for epidemiology in terms of understanding disease mechanism. It offers understanding disease mechanism so I am excited to explore that.
The Future:
SR: Do you envision changing the course of the work you are currently doing?
AH: I don’t know if I am thinking about changing the course of my work. I think there are ways to expand to new areas. A lot of the social structural things we think about impacting other health outcomes. There is potential for expanding the methods around that and how we think about it and applying it to other sorts of health issues. I think just thinking about approaches sort of broadly, there are lots of things we can think about doing in addition to the modeling work and other data science approaches. For example, we can use technology and big data to expand the programs here. I could see trying to integrate that more.
SR: What Challenges have you faced working here so far?
AH: I have been learning a lot in the process of modeling work. It’s more interdisciplinary than the work that I have done in the past. It’s challenging to think about how people in other disciplines might approach something. Thinking about how interventions we think about can be translated into computer models. It’s a challenging thing because models are an abstract representation of the population but they can’t be completely realistic. Any model is a simplification of really trying to balance reality with being computationally tractable is hard so I think those are challenges that are ongoing in the field that I am learning a lot in terms of how this could be beneficial for epidemiology in general. It’s always juggling more and more projects. I do a lot of analytical work and a lot of different projects. Keeping everything straight is challenging but it allows me to see a lot of different perspectives.
SR: If you had the flexibility to further extend the epidemiology program at CCHE, how do you picture it?
AH: I think there are a lot of interesting things we could do in terms of building initiatives with other departments like statistics, computer science, engineering. We can bring in more of the machine learning and data science approaches, perhaps incorporating that with modeling work. With technology, there are so many different opportunities for collecting data and we are sort of starting to think about these ways. There could be a lot of growth. There are probably interesting ways to combine data from other disciplines for analysis to address big-picture issues that are challenging to address with epidemiological tools. There is so much we can do but there are so many hours in the day. I hope to do more of that in the next couple of years.
Wrap Up:
SR: Before we wrap up this interview, I would love to know if you have any closing remarks.
AH: I think epidemiology is a great field. It offers a lot of different opportunities and there are so many different things you can do with it. I think it is important to be passionate about what you are doing. You develop this by working in the field, seeing firsthand the implication of the work you are doing. When pursuing training in graduate school, the most beneficial opportunities were doing the applied work and working with a community-based organization. I worked in Howard Brown before they had the 55th street clinic. They had a research department that was integrated with the clinical and service work and the research questions were aligned with and driven by the clinical and research side. Being involved with that was a valuable experience, and I met a lot of passionate people who were doing this work and that’s important to see. Seeing how the work you are doing is impactful has made me want to do HIV related work as well as working with dedicated and passionate people. Sometimes in academic research, you get stuck behind the computer, but I have had the opportunity to see the big picture and has made me a thoughtful researcher.