Megan Landes

Dr. Megan Landes is the Head of Division of Emergency Medicine at U of T's Department of Family & Community Medicine (DFCM). She has been at DFCM since 2010 and is currently an Associate Professor and Clinician Investigator, Research and Advocacy Program. Dr. Landes is also an attending staff doctor in the Emergency Department of the University Health Network (UHN), the University of Toronto’s largest downtown teaching hospital, and a Strategic Director for the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM), which is working with Addis Ababa University to deliver Ethiopia’s first emergency medicine residency program.

Affiliations: Staff Physician, Emergency Department, University Health Network; Director, Global Health Emergency Medicine (GHEM); Strategic Director, Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM)

Degrees: McMaster University BArts Sc; McGill MDCM; London School of Hygiene and Tropical Medicine (LSHTM) MSc

Research Synopsis

During the past ten years, she has worked clinically in Lesotho, Malawi and Ethiopia in both emergency medicine and HIV services. She specializes in operational research around the prevention of mother to child transmission of HIV in sub-Saharan Africa. Building on this expertise in HIV research in sub-Saharan Africa, Dr. Landes has recently turned her focus to expanding access to HIV testing in Ontario via suspected high prevalence emergency departments.

In partnership with the Ontario HIV Treatment Network, the Ministry of Health and Public Health Ontario, she is currently leading a consortium of 3 Ontario hospitals in implementing rapid/point-of-care HIV testing in their emergency departments (FAST HIV: Feasible, Accessible, Standard Testing for HIV in the Emergency Department).

Additionally, her research interests include the delivery of emergency medicine services in low-resource settings and she is a founding member and Director of the Global Health Emergency Medicine (GHEM) group at the University of Toronto.

Recent Publications

Landes M; van Lettow M; Nkhoma E; Tippett Barr B; Truewah Z; Schouten E; Jahn A; Auld A; Kalua T; van Oosterhout J. Low detectable post-partum viral load is associated with HIV transmission in Malawi’s prevention of mother-to-child transmission programme. Journal of the International AIDS Society. 2019, 22:e25290. [Principal Author].

Laytin A, Azazh A, Debebe F, Girma B, Beza L, Seid H, Reynolds T, Landes M, Wytsma J. Mixed methods process evaluation of pilot implementation of the African Federation for Emergency Medicine Trauma Data Project Protocol in Ethiopia. African Journal of Emergency Medicine. 2019, 9(Supplement):PS28-S31. [co-Author].

Landes M, Pfaff C, Zerihun M, Wondimagegn D, Sodhi S, Rouleau K, Kidd M. Calling non-governmental organizations to commit to strengthening primary health care to reach “health for all”: lessons from the 40 years following the Alma-Ata Declaration. African Journal of Primary Health Care and Family Medicine. 2019 April, 11(1):a1945. [Principal Author]

Tippett Barr BA, van Lettow M, van Oosterhout JJ, Landes M, Shiraishi RW, Amene E, Schouten E, Wadonda-Kabondo N, Gupta S, Auld AF, Kalua T, Jahn A. National estimates and risk factors associated with early mother-to-child transmission of HIV after implementation of option B+: a cross-sectional analysis. The Lancet HIV. 2018, November; https://doi.org/10.1016/S2352-3018(18)30316-3. [co-Author].

van Lettow M, Landes M, van Oosterhout JJ, Schouten E, Phiri H, Nkhoma E, Kalua T, Gupta S, Wadonda N, Jahn A & Tippett-Barr B. Prevention of mother-to-child transmission of HIV: a cross-sectional study in Malawi. Bull World Health Organ. 2018 April;96:256–265. [Shared Principal Author].

van Lettow M, Tweya H, Rosenberg NE, Trapence C, Kayoyo V, Kasende F, Kaunda B, Hosseinipour MC, Eliya M, Cataldo F, Gugsa S, Phiri S, the PURE Malawi Consortium. Baseline characteristics of study sites and women enrolled in a three-arm cluster randomized controlled trial: PMTCT uptake and retention (pure) Malawi. Reproductive Health. 2017 Jul 11;14(1):82. [Consortium Author]

Phiri S, Tweya H, van Lettow M, Rosenberg NE, Trapence C, Kapito-Tembo A, Kaunda-Khangamwa B, Kasende F, Kayoyo V, Cataldo F, Stanley C, Gugsa S, Sampathkumar V, Schouten E, Chiwaula L, Eliya M, Chimbwandira F, Hosseinipour M, the PURE Malawi Consortium. Impact of Facility-and Community-Based Peer Support Models on Maternal Uptake and Retention in Malawi's Option B+ HIV Prevention of Mother-to-Child Transmission Program: A 3-Arm Cluster Randomized Controlled Trial (PURE Malawi). Journal of Acquired Immune Deficiency Syndromes. 2017 Jun 1;75:S140-8. [Consortium Author]

Hosseinipour M, Nelson JA, Trapence C, Rutstein SE, Kasende F, Kayoyo V, Kaunda-Khangamwa B, Compliment K, Stanley C, Cataldo F, van Lettow M, Rosenberg N, Tweya H, Gugsa S, Sampathkumar V, Schouten E, Eliya M, Chimbwandira F, Chiwaula L, Kapito-Tembo A, Phiri, the PURE Malawi Consortium. Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study. Journal of Acquired Immune Deficiency Syndromes. 2017 Jun 1;75:S149-55. [Consortium Author]

Landes M, Venugopal R, Berman S, Heffernan S, Maskalyk J, Azazh A. Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre. African Journal of Emergency Medicine. 2017 May 24 [Principal Author].

Stachura M, Landes M, Aklilu F, Venugopal R, Hunchak C, Berman S, Maskalyk J, Sarrazin J, Kebede T, Azazh A. Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency department in Addis Ababa Ethiopia. African Journal of Emergency Medicine. 2017 May 17. [Senior Author].

Landes M, Thompson C, Mwinjiwa E, Thaulo E, Gondwe C, Akello H, Chan AK. Task shifting of triage to peer expert informal care providers at a tertiary referral HIV clinic in Malawi: a cross-sectional operational evaluation. BMC Health Services Research. 2017 May 9;17(1):341. [Principal Author]

Tubman M, Maskalyk J, MacKinnon D, Venugopal R, Fremes E, Ritchie LP, Azazh A, Landes M. Tackling challenges of global health electives: Resident experiences of a structured and supervised medicine elective within an existing global health partnership. Canadian Medical Education Journal. 2017 Apr 20;8(2):4-10. [Senior Author].

Kuipers MJ, Eapen A, Lockwood J, Berman S, Vaillancourt S, Maskalyk J, Azazh A, Landes M. Examining critical factors affecting graduate retention from an emergency medicine training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives. Canadian Medical Education Journal. 2017 Apr 20;8(2):61-74. [Senior Author]

Kane J, Landes M, Carroll C, Nolen A, Sodhi S. A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa. BMC Family Practice. 2017 Mar 23;18(1):46. [co-Author].

Salmon M, Landes M, Hunchak C, Paluku J, Kalisya LM, Salmon C, Muller MM, Wachira B, Mangan J, Chhaganlal K, Kalanzi J. Getting It Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent. Annals of Emergency Medicine. 2017 Feb 28;69(2):218-26. [co-Author].

Dovel K, Yeatman S, van Oosterhout JJ, Chan A, Mantengeni A, Landes M, Bedell R, Kawalazira G, Sodhi S. Trends in ART initiation among men and non-pregnant/non-breastfeeding women before and after option B+ in Southern Malawi. PLoS one. 2016 Dec 21;11(12):e0165025. [co-Author].

Landes M, Sodhi S, Matengeni A, Meaney C, van Lettow M, Chan AK, van Oosterhout JJ. Characteristics and outcomes of women initiating ART during pregnancy versus breastfeeding in Option B+ in Malawi. BMC Public Health. 2016 Aug 4;16(1):713. [Principal Author]

Ritchie LM, van Lettow M, Hosseinipour MC, Rosenberg NE, Phiri S, Landes M, Cataldo F, Straus SE. The effectiveness of interventions to improve uptake and retention of HIV-infected pregnant and breastfeeding women and their infants in prevention of mother-to-child transmission care programs in low-and middle-income countries: protocol for a systematic review and meta-analysis. Systematic Reviews. 2015 Nov 3;4(1):144. [co-Author]

Rosenberg NE, van Lettow M, Tweya H, Kapito-Tembo A, Bourdon CM, Cataldo F, Chiwaula L, Sampathkumar V, Trapence C, Kayoyo V, Kasende F, Blessings K, Speight C, Schouten E, Michael E, Hosseinipour M, Phiri S, the PURE Malawi Consortium. Improving PMTCT uptake and retention services through novel approaches in peer-based family-supported care in the clinic and community: a three-arm cluster randomized trial (PURE Malawi). Journal of Acquired Immune Deficiency Syndromes (1999). 2014 Nov 1;67(0 2):S114. [Consortium Author]

Landes M, Puchalski Ritchie L, Chiwaya F, Joshua M. Characteristics of and risk factors for early pediatric mortality at Zomba Central Hospital, Malawi. International Journal of TROPICAL DISEASE & Health. 2014 Apr;4(4):444-56. [Principal Author]

Bedell RA, van Lettow M, Landes M. Women's choices regarding HIV testing, disclosure and partner involvement in infant feeding and care in a rural district of Malawi with high HIV prevalence. AIDS care. 2014 Apr 3;26(4):483-6. [Senior Author]

van Lettow M, Bedell R, Mayuni I, Mateyu G, Landes M, Chan AK, van Schoor V, Beyene T, Harries AD, Chu S, Mganga A. Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+). Journal of the International AIDS Society. 2014;17(1). [co-Author]

Maskalyk J, Landes M. The Toronto Addis Ababa Academic Collaboration in Emergency Medicine: Building a partnership. Ethiopian Journal of Medicine. July 2014:45-8. [co-Principal Author]

Azazh A, Teklu S, Woldetsadi A, Seyoum N, Geremew H, Busse H, Tefera G, Wubben R, Rankin P, Tupesis JP, Landes M Emergency medicine and its development in Ethiopia with emphasis on the role of Addis Ababa University, School of Medicine, Emergency Medicine Department. Ethiopian Medical Journal. 2014 Jul;Suppl 2:1-12. [co-Author]

Landes M, van Lettow M, Cataldo F, Chan AK, Tippett Barr B, Harries AD, Bedell R. Building a national direction for research in the prevention of mother to child transmission of HIV: results from a national prioritization initiative in Malawi. Health Res Policy Syst. 2013 Oct 26;11:40. [Principal Author]

Nowacki AK, Landes M, Azazh A, Puchalski Ritchie LM. A review of published literature on emergency medicine training programs in low- and middle-income countries. Int J Emerg Med. 2013 Jul 17;6(1):26. [co-Author]

Landes M, van Lettow M, Bedell R, Mayuni I, Chan AK, Tenthani L, Schouten E. Mortality and health outcomes in HIV-infected and HIV-uninfected mothers at 18-20 months postpartum in Zomba District, Malawi. PLoS One. 2012;7(9):e44396. [Principal Author]

Landes M, van Lettow M, Chan AK, Mayuni I, Schouten EJ, Bedell RA. Mortality and health outcomes of HIV-exposed and unexposed children in a PMTCT cohort in Malawi. PLoS One. 2012;7(10):e47337. [Principal Author]

van Lettow M, Bedell R, Landes M, Gawa L, Gatto S, Mayuni I, Chan AK, Tenthani L, Schouten E. Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT) program in Zomba district, Malawi. BMC public health. 2011 Jun 3;11(1):426. [co-Author]

Landes M, Newell ML, Barlow P, Fiore S, Malyuta R, Martinelli P, Posokhova S, Savasi V, Semenenko I, Stelmah A, Tibaldi C, Thorne C. Hepatitis B or hepatitis C coinfection in HIV-infected pregnant women in Europe. HIV Medicine. 2008 Aug 1;9(7):526-34. [Principal Author]

Landes M, Thorne C, Barlow P, Fiore S, Malyuta R, Martinelli P, Posokhova S, Savasi V, Semenenko I, Stelmah A, Tibaldi C, Newell ML. Prevalence of sexually transmitted infections in HIV-1 infected pregnant women in Europe. European journal of epidemiology. 2007;22(12):925-36. [Principal Author]

Landes M. Can context justify an ethical double standard for clinical research in developing countries? Globalization and Health. 2005 Jul 26;1(1):11 [Principal Author]

Honours and Awards

Name:
Description:

2019: Excellence in Leadership Award, Department of Family & Community Medicine, University of Toronto.

2018: Excellence in Research, Senior Researcher, University Health Network Emergency Department

2016: Faculty Award for Excellence in Global Health, Department of Family and Community Medicine, University of Toronto.

2013: Award of Excellence, Dalla Lana School of Public Health, University of Toronto. Global Health Education Initiative for Leadership of Module on Complex Humanitarian Emergencies.

2013: Louise Naismith Award, Department of Family and Community Medicine, University of Toronto.

2013: Young Investigator Award, Department of Family and Community Medicine, University of Toronto. For study: “Head Trauma in the Black Lion Hospital ED, Ethiopia.”

Grants

2019 July – present: Senior Advisor. A program evaluation of the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). Education Development Fund, Office of Educational Scholarship, Department of Family and Community Medicine, University of Toronto. PI(s): Eileen Cheung and Tilahun Jiru. Collaborator(s): Azazh A, Engida H, Bryan J, Zewdu T, Hunchak C, Meshkat N, Maskalyk J, Wondimagegn D, Kuper A, Whitehead C. 19,995 CAD.

2019 April – present: Principal Investigator. FAST-HIV: Feasible Accessible Standard Testing (FAST) for HIV in the ED. OHTN Incubator Project Funding. Collaborator(s): Hulme J, Xie E, Sanaee L, Bogoch I, Puchalski Ritchie L, Poutanen S, Mazzulli T, Kroch A, Murti M. 211,817 CAD.

2019 April – present: Principal Investigator. FAST-HIV: Feasible Accessible Standard Testing (FAST) for HIV in the ED. AFP Innovation Fund: Round 6. Collaborator(s): Hulme J, Xie E, Sanaee L, Bogoch I, Puchalski Ritchie L, Poutanen S, Mazzulli T, Kroch A, Murti M. 174,854 CAD.

2018 June – present: Co-investigator. Fostering emergency physician-advocates: Current status of the health advocate role in Canadian EM training programs. Educational Development Fund grant, Office of Educational Scholarship, Department of Family and Community Medicine, University of Toronto. PI: Dr. Jennifer Hulme. 19,800 CAD.

2018 June – present: Co-investigator. Global Health Simulation: Mechanisms for a novel education method. Art of the Possible grant, Office of Educational Scholarship, Department of Family and Community Medicine, University of Toronto. PI: Dr. Edward Xie. 5,000 CAD.

2018 July - present: Co-investigator. Evaluating support interventions for adolescents living with HIV in Malawi. PI: Joep van Oosterhout. Medical Research Council (UK): 1.2 million CAD.

2017 July - present: Principal Investigator. Laying the Groundwork: Developing a Global Health Emergency Medicine Fellowship at the University of Toronto. Education Development Fund Grant, Faculty of Medicine, University of Toronto. Collaborator(s): Dr. James Maskalyk (Dept of Medicine), Dr. Lisa Puchalski Ritchie (Dept of Medicine), Dr. Margaret Salmon (Dept of Medicine). Senior Advisors: Dr. Nazanin Meshkat (Dept of Medicine), Dr. Cheryl Hunchak (DFCM), Dr. Anil Chopra (Dept of Medicine), Dr. Eric Letovsky (DFCM). 20,000 CAD.

2016 Nov - present: Co-principal Investigator. Hepatitis B and C among HIV-infected women and their infants. Sub-study of NEMAPP. Centers for Disease Control. 170,000 USD.

2016 July - present: Co-investigator. Development of a sepsis protocol for Black Lion Hospital, Addis Ababa University. PI: Dr. Lisa Puchalski Ritchie, CIHR Knowledge Translation Grant. 275,000 CAD.

2016 Jan - present: Principal Investigator. 5-year program evaluation of the Toronto Addis Ababa Academic Collaboration in Emergency Medicine. Office of Educational Scholarship, DFCM. University of Toronto. 5,000 CAD.

2015 Sept - present: Principal Investigator. Operational Research Grant for Black Lion Emergency Department: Trauma Registry Outcomes. University Health Network. ED Practice Plan Pilot Grant. 3,950 CAD.

2015 Nov - present: Co-investigator. Epidemiology, clinical evaluation and outcome of head injury at Black Lion Hospital. Innovation Fund, Addis Ababa University PI: Dr. T. Laeke. 23,800 CAD.

2014 Jul - 2015 Jun: Evaluation of short-term field-based global health training programs through trainee and host community perspectives. Educational Development Grant, Faculty of Medicine, Univeristy of Toronto. PI: Sodhi, S. Collaborator(s): Co-Is: Dr. Megan Landes (DFCM), Dr. Katherine Rouleau (DFCM), Dr. Adrienne Chan (Dept of Medicine, Infectious Disease), Dr. Eugenia Pillotis (Dept of Medicine, Hematology), Dr. Aklilu Tumebo (Addis Ababa University, Ethiopia), Dr. Abdulaziz Sheriff (Addis Ababa University), Dr. Joep van Oosterhout (Dignitas International Malawi). 17,000 CAD.

2013 – 2018: National Evaluation of the Malawi Program for the Prevention of Maternal to Child Transmission of HIV. Centers for Disease Control (CDC). PEPFAR. PI: Beth Tippett Barr, Frank Chimbwandira. Collaborator(s): Schouten E, van Lettow M, van Oosterhout J. 4,900,000 USD. A nationally representative prospective cohort to evaluate Option B+ (a universal test and treat strategy for all HIV-infected pregnant and breastfeeding mothers). 3300 mother-child pairs will be followed until 24 months to determine HIV-free survival along with uptake, retention and adherence measures. I am the scientific lead for a nested cohort of 1300 mother-child pairs to be followed to 48 months for extended retention measures and enhanced clinical outcomes (including resistance, impact on recurrent pregnancies).

2013 – 2015: The Toronto Addis Ababa Academic Collaboration in Emergency Medicine. Grand Challenges Canada. Rising Stars Round Five. Collaborator(s): Maskalyk JM, Hunchak C, Azaj A. 100,000 CAD. For further development of a collaboration between the University of Toronto and Addis Ababa University to train the first cohorts of emergency medicine residents in Ethiopia.

2013: Enhanced and enriched observation cohort for key populations in the Zomba Observational Cohort Study. Canadian Institutes of Health Research (CIHR). PI: Sumeet Sodhi. 100,000 CAD.

2012 – 2016: PURE: Improving uptake and retention in PMTCT services through novel approaches in family supported care and in community peer-outreach support in Malawi. WHO-CIDA Collaborative Grant. PI: Sam Phiri. 1,749,828 CAD. A cluster-based randomized control trial to compare standard of care, facility based programs and community based programs to support mothers entering into HIV-care as a part of Option B+ (a national universal test and treat strategy for all pregnant and breastfeeding mothers).

2012 – 2014: Principal Investigator. Partnering to Establish Emergency Medicine in Ethiopia: Development, implementation and evaluation of a postgraduate residency training program at Addis Ababa University. International Development Research Centre (IDRC). Collaborator(s): Maskalyk JM, Hunchak C, Teklu S, Azaj A. 60,000 CAD.

2011 – 2015: Principal Investigator. Operational Research Grant for Black Lion Emergency Department: Head Trauma Outcomes. University Health Network. ED Practice Plan Pilot Grant. 3,950 CAD.

2011 – 2013: Principal Investigator. Early Mortality on the Pediatrics Ward, Zomba Central Hospital, Malawi. University Health Network. ED Practice Plan Pilot Grant. 3,850 CAD.

2010 – 2012: Co-Investigator. Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT) program for 382 mother-child pairs in Zomba district, Malawi. Operational Research Dignitas International. PI: van Lettow, M. 10,000 CAD. A retrospective cohort study at 18-20 months post-partum examining PMTCT utilization by HIV-infected mothers and comparing outcomes of HIV-infected mothers and child pairs to HIV-uninfected mothers.