About

Dr. R. Scott McClelland is a Professor of Epidemiology, Medicine, and Global Health at the University of Washington. He leads a trainee-driven research program that links Seattle and Kenya in collaboration with the Fred Hutchinson Cancer Research Center and the University of Nairobi. His research spans a range of topics including HIV, sexually transmitted infections, women's health, key populations epidemiology, clinical trials, and implementation research. Dr. McClelland's work focuses on understanding the impact of periconceptual vaginal microbiota on women's risk of preterm birth, developing and testing interventions such as SMS-based support for HIV treatment in high-risk women, and creating diagnostic tools for cervical cancer detection in low-resource settings. His research also explores women's life course events and their potential influence on HIV transmission. Dr. McClelland holds an MD, MPH, and BS from the University of Washington and is actively involved in advancing public health through his research and collaborations.

Research topics

• Internal medicine
• Medicine
• Immunology

Selected publications

• Self-collection for high-risk HPV-RNA detection among HIV-seropositive and HIV-seronegative women engaged in sex work in Kenya

  Sexually Transmitted Infections · 2025-04-01

  article

  BACKGROUND: Evidence of self-collection human papillomavirus (HPV)-RNA testing in cervical cancer screening is limited among women with HIV (WHIV). Most studies are in low-risk patient populations in high-income countries. We examine the prevalence of high-risk HPV (hrHPV) using the APTIMA HPV-RNA assay on self-collected versus provider-collected specimens, and the associated risk factors for high-grade cervical intraepithelial neoplasia (CIN2/3) among women engaged in sex work in Kenya. Among WHIV, we examine the performance of both collection methods for the detection of CIN2/3. METHODS: Participants were aged ≥18 years, non-pregnant and had no previous treatment for cervical precancer. The screening process included self-collection of cervicovaginal samples using a Viba cytobrush (Rovers), provider-collected cervical samples, visual inspection with acetic acid (VIA) and Pap smear. The APTIMA HPV Assay (Hologic) was used to detect E6/E7 oncogene RNA of 14 hrHPV types in both self-collected and on provider-collected samples. Risk factors for CIN2/3 were determined via multivariable logistic regression. We estimated test characteristics for each screening method for CIN2/3 detection. RESULTS: A total of 400 women (194 WHIV, 206 women without HIV) underwent screening between 2013 and 2018, with 399 valid HPV results. WHIV had a higher prevalence of hrHPV by self-collection compared with women without HIV (44.0% vs 29.6%, p<0.05) and CIN2/3 (19.0% vs 9.7%, p<0.05). After adjusting for age and HIV status, hrHPV-positivity increased the risk of CIN2/3 by 13 to 20 times. Among WHIV, the sensitivity for CIN2/3 detection was similar between self-collection (85% (66-96)) and provider-collection (93% (76-99)), both of which were higher than the sensitivity of high-grade cytology (high-grade squamous intraepithelial lesion cut-off) (47% (95% CI 23 to 72)). The specificity for both collection methods (self: 66% (95% CI 57 to 75) and provider: 67% (95% CI 58 to 75)) was lower than cytology (85% (95% CI 78 to 91)). CONCLUSION: Self-collection for HPV-RNA testing performed similarly to provider-collection among WHIV. For WHIV, while the higher sensitivity of HPV-RNA testing compared with cytology for the detection of clinically relevant cervical disease is important, the lower specificity supports the inclusion of a triage test in the screening algorithm.

  PublisherDOI

• Cross-sectional study evaluating organizational climate, change commitment, and change efficacy for predicting family planning clinics’ success in increasing HIV counseling and testing in Mombasa, Kenya

  PLOS Global Public Health · 2025-12-31

  articleOpen accessSenior author

  Increasing HIV testing and counselling (HTC) is a first step to reducing HIV transmission. Implementing HTC in family planning (FP) clinics has been proposed to increase HIV testing coverage in at-risk populations. The Systems Analysis and Improvement Approach (SAIA) was used to improve HTC rates in FP clinics in Mombasa, Kenya. This hypothesis-generating exploratory analysis evaluated the associations between organizational climate characteristics, organizational readiness for implementing change, and successful implementation of HTC. Surveys were conducted with clinic managers and staff from FP clinics implementing SAIA to increase HTC. Likert-style questions were used to characterize organizational climate metrics and organizational readiness for implementing change (ORIC). Linear regression was performed to examine the association between organizational climate metrics, ORIC domains, and two FP client outcomes: 1) percentage of clients receiving pre-HIV test counseling, and 2) percentage of clients tested for HIV. Eleven clinic staff and 10 clinic managers completed the surveys. For clinic staff, higher innovation and flexibility scores were associated with higher change commitment (β = 0.20, CI 0.09-0.31, p = 0.001) and change efficacy (β = 0.17, CI 0.07-0.26, p = 0.002). Higher clinic manager scores for innovation and flexibility were associated with a higher change commitment (β = 0.44, CI 0.04-0.84, p = 0.03). Additionally, clinic managers' scores for management support (β = 0.25, CI 0.06-0.45, p = 0.01), commitment to facility (β = 0.78, CI 0.60-0.96, p = 0.001), and relative priority (β = 0.24, CI 0.08-0.39, p = 0.004) were positively associated with higher change commitment and change efficacy. In contrast, clinic managers' scores for tradition were negatively associated with change commitment (β = -0.38, CI -0.75-0.01, p = 0.05). Clinic staff perceptions of management support were positively associated with the proportion of clients counseled for HIV testing (β = 1.20, CI 0.08-2.32, p = 0.04). Support from leadership and innovation/flexibility are important predictors of change commitment and change efficacy. Strong management support may increase the likelihood of successful implementation of SAIA to improve HTC.

  PublisherDOI

• Assessing the relationship between menstrual products and reproductive and urogenital tract infections (RUTIs): a systematic review evaluating the evidence and recommendations for future research

  medRxiv · 2025-09-02

  preprintOpen access

  Abstract Background Concerns regarding the effects of non-tampon menstrual products on reproductive and urogenital health, particularly the risk of infections, is an area of ongoing investigation. We conducted an updated systematic review to assess methodological quality of the current evidence assessing associations between menstrual product use and reproductive and urogenital infections (RUTIs), and offer recommendations for future research. Methods Three databases (PubMed, Web of Science, United States Food and Drug Administration Manufacturer User Facility Device Experience) were searched for relevant published studies or product safety reports up to October 13, 2024. We included studies on menstruators of any age and geography assessing for any reusable/disposable menstrual pads, menstrual cups, or homemade alternatives worn only for menstrual absorbency compared to other menstrual products or no product use, with outcomes centered on RUTIs. Protocols, reviews, and studies assessing only tampons or non-menstrual absorbents were excluded. Results were evaluated and synthesized using tabular methods according to measures of association, and across four criteria categories 1) product definition, 2) comparator definition, 3) outcome definition, and 4) confounder consideration. Results Thirty-one studies were included in this review. Most studies clearly defined outcomes and considered necessary confounders. In contrast, studies with well-defined products (6.5%) and comparator products (9.7%) were uncommon. Ten studies (32.2%) reported some data on four or more confounders, and seventeen (54.8%) defined their infectious outcomes and included laboratory confirmation. A meta-analysis was not possible due to data heterogeneity across product, comparator, and outcome definitions. Overall, associations between menstrual products and RUTIs are inconclusive. Conclusion Future studies should 1) clearly define product and comparator type, material, frequency of change, and washing, drying, and storage practices for reusable products, 2) prioritize laboratory or clinician-confirmed outcomes over self-reported symptoms, and 3) adjust for relevant confounders.

  PublisherOA PDFDOI

• Correction to: Preference of specimen collection methods for human papillomavirus detection for cervical cancer screening: a cross-sectional study of high-risk women in Mombasa, Kenya

  UNC Libraries · 2025-07-18

  articleOpen access
  PublisherDOI

• Single-Cell Transcriptomics Reveals Depletion and Dysregulation of <i>Mycobacterium tuberculosis</i>–Specific Th1 and Th17 Cells Early After Acquisition of Human Immunodeficiency Virus

  The Journal of Infectious Diseases · 2025-07-03 · 2 citations

  article

  Human immunodeficiency virus (HIV) significantly increases the risk of developing tuberculosis (TB) and is associated with impaired CD4 T-cell responses to Mycobacterium tuberculosis (Mtb). We evaluated the frequency and functional capacity of Mtb-specific CD4 T cells in individuals with and without HIV using flow cytometry and performed single-cell RNA sequencing on these cells longitudinally in a subset of individuals before and after acquisition of HIV. Our findings reveal preferential depletion and functional impairment of Mtb-specific CD4 T cells early after acquisition of HIV, characterized by reduced cytokine production, loss of effector functions, and transcriptional dysregulation. Mtb-specific T-helper 1 (Th1) and T-helper 17 (Th17) cells decreased, whereas TCF7+ stem-like cells were enriched following acquisition of HIV. Pathway analysis revealed upregulation of hypoxia and Wnt signaling, and downregulation of cell adhesion, migration, antigen processing, and cytokine signaling pathways. These findings provide novel insights into HIV-mediated dysregulation of CD4 T-cell responses to Mtb.

  PublisherDOI

• <i>Trichomonas vaginalis</i> Among Cisgender Women Taking Doxycycline Postexposure Prophylaxis

  The Journal of Infectious Diseases · 2025-10-08

  articleOpen access

  Doxycycline treats and prevents several bacterial and parasitic infections and has been proposed as a possible treatment for Trichomonas vaginalis. Nested in a trial of doxycycline postexposure prophylaxis among cisgender women in Kenya, we conducted a secondary analysis of incident T. vaginalis infections. Among 224 cisgender women randomized to doxycycline postexposure prophylaxis and 225 to standard-of-care, there were 27 T. vaginalis diagnoses in the doxycycline postexposure prophylaxis group and 29 in the standard-of-care group (RR: 0.96, 95% CI: 0.54-1.73, P = .9). Understanding doxycycline postexposure prophylaxis's impact on T. vaginalis remains an important public health question that warrants further investigation.

  PublisherOA PDFDOI

• Effect of Bacterial Vaginosis Treatment on Cervical T Cell and Langerhans Cell Concentrations

  American Journal of Obstetrics and Gynecology · 2025-11-01

  articleSenior author
  PublisherDOI

• Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Subvariant Neutralization Following a Primary Vaccine Series of NVX-CoV2373 and BNT162b2 Monovalent Booster Vaccine

  Open Forum Infectious Diseases · 2024-01-03 · 4 citations

  articleOpen access

  We evaluated the immunologic response to a novel vaccine regimen that included 2 doses of NVX-CoV2373 (Novavax) followed by 1 dose of BNT162b2 (Pfizer-BioNTech) monovalent booster vaccine. A durable neutralizing antibody response to Omicron BA.4/BA.5 and BA.1 variants was observed at month 6 after the booster, while immune escape was noted for the XBB.1.5 variant.

  PublisherOA PDFDOI

• Intimate partner sexual violence is associated with unhealthy alcohol use among Kenyan women engaged in sex work

  Drug and Alcohol Dependence Reports · 2024-12-24 · 1 citations

  articleOpen access

  Aim: Unhealthy alcohol use is often correlated with experiences of intimate partner violence (IPV). We investigated how different types of IPV (sexual, physical, emotional, and financial) were associated with unhealthy alcohol use among women engaged in sex work in Mombasa, Kenya. Methods: This cross-sectional study included 283 HIV-negative women who engaged in sex work recruited from an ongoing cohort study. Modified Poisson analysis was used to assess associations between recent (≤ 12 months) or past (> 12 months) experiences of sexual, physical, emotional, or financial IPV and unhealthy alcohol use defined as an Alcohol Use Disorders Identification Test score ≥ 8. Results: Among 283 participants, 34.6 % had unhealthy alcohol use. Physical (62.5 %), emotional (60.4 %), and financial (66.4 %) IPV occurred more frequently than sexual IPV (43.8 %). Adjusted risk ratios (ARR) for relationships between physical and financial IPV and unhealthy alcohol use were elevated but not statistically significant. Compared to participants who had not experienced sexual IPV, those who had experienced recent or past sexual IPV had an increased risk of unhealthy alcohol use (ARR 1.56, 95 % confidence interval [1.09, 2.23] and ARR 1.48, 95 % confidence interval [0.97, 2.25], respectively). Conclusion: Sexual IPV was associated with unhealthy alcohol use among Kenyan women who engage in sex work. Physical, emotional, and financial IPV were also highly prevalent in the study population, though not associated with unhealthy alcohol use. These findings affirm the potential benefit of providing integrated IPV and alcohol treatment services focused on recovery after experiences of IPV for this vulnerable population.

  PublisherDOI

• Sexual Violence, Genital Cytokines, and Colposcopy Findings: A Cross-Sectional Study of Women Engaged in Sex Work in Mombasa, Kenya

  Sexually Transmitted Diseases · 2024-09-05 · 2 citations

  articleOpen accessCorresponding

  BACKGROUND: Sexual violence (SV) increases human immunodeficiency virus (HIV) susceptibility in a sustained manner. This study evaluated genital cytokines and colposcopy findings in women reporting both recent and more remote SV. METHODS: A cross-sectional study of HIV-1 negative Kenyan women who engage in sex work was performed. Cervicovaginal fluid was collected by menstrual cup and cytokines (IFNγ, TNFα, IL-1β, IL-6, IL-10, MIP-1α, MIP-1β, and CXCL10) measured using chemiluminescence. Cervical injury was assessed by colposcopy. Associations between recent (≤30 days prior), more remote (>30 days prior), and no (reference category) SV exposure and cytokine concentrations were evaluated using linear regression. RESULTS: Among 282 participants, 25 (8.9%) reported recent SV and 123 (43.6%) reported more remote SV. Only two cytokines (IL-10 and CXCL10) were associated with the 3-category SV variable in bivariable modeling at the prespecified cutoff ( P < 0.2) and carried forward. In multivariable analyses, more remote SV (β = 0.72; 95% confidence interval [CI], 0.06-1.38; P = 0.03), but not recent SV (β = 0.20; 95% CI, -0.99 to 1.39; P = 0.74) was associated with cervicovaginal IL-10 compared with no SV. Recent (β = 0.36; 95% CI, -0.94 to 1.67; P = 0.58) and more remote (β = 0.51; 95% CI, -0.21 to 1.24; P = 0.16) SV were not associated with CXCL10 compared with no SV. Cervical epithelial friability (χ 2 = 1.3, P = 0.51), erythema (χ 2 = 2.9, P = 0.24), vascular disruption (χ 2 = 1.4; P = 0.50), epithelial disruption (χ 2 = 2.6, P = 0.27), or any colposcopy finding (χ 2 = 1.2, P = 0.54) were not associated with SV category by χ 2 test. CONCLUSIONS: The mechanism linking SV to sustained increases in HIV susceptibility may not be related to persistent genital inflammation or injury.

  PublisherOA PDFDOI

Recent grants

• RCT of an Implementation Science Tool to Integrate HIV testing into Family Planning Services

  NIH · $863k · 2016–2023

• NIH Grant R21MH107217

  NIH · $459k · 2017

• NIH Grant R01AI099106

  NIH · $1.8M · 2016

• NIH Grant R01HD072617

  NIH · $2.1M · 2018

• NIH Grant P01HD064915

  NIH · $17.7M · 2015

Frequent coauthors

• Barbra A. Richardson

  University of Washington

  183 shared

• Walter Jaoko

  University of Nairobi

  116 shared

• Susan M. Graham

  86 shared

• Jared M. Baeten

  Gilead Sciences (United States)

  84 shared

• Kishorchandra Mandaliya

  Pwani University

  76 shared

• John Kinuthia

  Kenyatta National Hospital

  75 shared

• Jennifer E. Balkus

  University of Washington

  67 shared

• Ludo Lavreys

  Janssen (Netherlands)

  64 shared