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Odeny BM, Njoroge A, Gloyd S, Hughes JP, Wagenaar BH, Odhiambo J, Nyagah LM, Manya A, Oghera OW, Puttkammer N. Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: a nationwide retrospective cohort study. BMC Health Serv Res 2023; 23:1139. [PMID: 37872540 PMCID: PMC10594801 DOI: 10.1186/s12913-023-10133-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya. METHODS We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Completeness refers to the presence of the appropriate amount of data. Consistency refers to uniformity of data across multiple indicators. Discrepancy (measured on a Z-scale) refers to the degree of alignment (or lack thereof) of data with rules that defined the possible valid values for the data. RESULTS A total of 5,610 unique facility-quarters were extracted from KHIS. The mean completeness score was 61.1% [standard deviation (SD) = 27%]. The mean consistency score was 80% (SD = 16.4%). The mean discrepancy score was 0.07 (SD = 0.22). A strong and positive correlation was identified between the consistency score and discrepancy score (correlation coefficient = 0.77), whereas the correlation of either score with the completeness score was low with a correlation coefficient of -0.12 (with consistency score) and -0.36 (with discrepancy score). General HIV indicators were more complete, but less consistent, and less plausible than PMTCT indicators. CONCLUSION We observed a lack of correlation between the completeness score and the other two scores. As such, for a holistic DQA, completeness assessment should be paired with the measurement of either consistency or discrepancy to reflect distinct dimensions of data quality. Given the complexity of the discrepancy score, we recommend the simpler consistency score, since they were highly correlated. Routine use of composite scores on KHIS data could enhance efficiencies in DQA at scale as digitization of health information expands and could be applied to other health sectors beyondHIV clinics.
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Affiliation(s)
- Beryne M Odeny
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
| | - Anne Njoroge
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
| | - Steve Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Nancy Puttkammer
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Lwamulungi E, Qureshi Z, Obimbo M, Ogutu O, Cheserem E, Kosgei RJ, Walong E, Inyangala D, Nyakundi GG, Ndavi PM, Osoti AO, Ondieki DK, Pulei AN, Njoroge A, Masyuko S, Wachira CM. Placental characteristics and neonatal weights among women with malaria-preeclampsia comorbidity and healthy pregnancies. PLoS One 2023; 18:e0291172. [PMID: 37856468 PMCID: PMC10586625 DOI: 10.1371/journal.pone.0291172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/16/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Malaria and preeclampsia are leading causes of maternal morbidity and mortality in sub-Saharan Africa. They contribute significantly to poor perinatal outcomes like low neonatal weight by causing considerable placental morphological changes that impair placental function. Previous studies have described the effects of either condition on the placental structure but the structure of the placenta in malaria-preeclampsia comorbidity is largely understudied despite its high burden. This study aimed to compare the placental characteristics and neonatal weights among women with malaria-preeclampsia comorbidity versus those with healthy pregnancies. METHODOLOGY We conducted a retrospective cohort study among 24 women with malaria-preeclampsia comorbidity and 24 women with healthy pregnancies at a County Hospital in Western Kenya. Neonatal weights, gross and histo-morphometric placental characteristics were compared among the two groups. RESULTS There was a significant reduction in neonatal weights (P<0.001), placental weights (P = 0.028), cord length (P<0.001), and cord diameter (P<0.001) among women with malaria-preeclampsia comorbidity compared to those with healthy pregnancies. There was also a significant reduction in villous maturity (P = 0.016) and villous volume density (P = 0.012) with increased villous vascularity (P<0.007) among women with malaria-preeclampsia comorbidity compared to those with healthy pregnancies. CONCLUSION Placental villous maturity and villous volume density are significantly reduced in patients with malaria-preeclampsia comorbidity with a compensatory increase in villous vascularity. This leads to impaired placental function that contributes to lower neonatal weights.
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Affiliation(s)
- Everett Lwamulungi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Zahida Qureshi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Moses Obimbo
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Omondi Ogutu
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Eunice Cheserem
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Rose J. Kosgei
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Edwin Walong
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | - Dennis Inyangala
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | - George G. Nyakundi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Patrick M. Ndavi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Alfred O. Osoti
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Diana K. Ondieki
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Anne N. Pulei
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Anne Njoroge
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United states of America
| | - Sarah Masyuko
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United states of America
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Wittenauer R, Dolan SB, Njoroge A, Onyango P, Owiso G, Rabinowitz P, Puttkammer N. Usability and Acceptability of Electronic Immunization Registry Data Entry Workflows From the Health Care Worker Perspective in Siaya, Kenya (Part 3): Pre-Post Study. JMIR Form Res 2023; 7:e39383. [PMID: 36995755 PMCID: PMC10131729 DOI: 10.2196/39383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate the challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health and the International Training and Education Center for Health Kenya implemented an EIR system in 161 immunizing clinics in Siaya County between 2018 and 2019. The successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the health care workers (HCWs) using the EIR. OBJECTIVE This study aimed to evaluate HCWs' perceptions of the usability and acceptability of multiple clinic workflows using the new EIR. METHODS We performed a mixed methods pre-post study using semistructured interviews with HCWs at 6 facilities in Siaya County, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after the implementation of 3 different workflow modifications (n=24 interviews). The baseline state was dual data entry with paper records and the EIR. We then implemented 3 workflow modifications for 1 full day each: fully paperless data entry, preparation of an appointment diary before patient visits for the day, and a combination of the 2 workflows. We compared ratings and themes across interviews after each of the 4 workflows to understand the changes in the usability and acceptability of the EIR. RESULTS HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow most favorably. In all workflows, HCWs' perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of data entry when using the EIR, and ease of identification of errors. Perceived barriers to the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors in saving records and missing fields, and workflow challenges such as the dual data entry burden of using paper and digital tools simultaneously. CONCLUSIONS Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon the presence of supporting contextual clinic factors and the resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation, both for Siaya's program and for other efforts around the globe, as digital health interventions become more widely used.
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Affiliation(s)
- Rachel Wittenauer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Samantha B Dolan
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anne Njoroge
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
| | | | - George Owiso
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
| | - Peter Rabinowitz
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- Department of Global Health, University of Washington, Seattle, WA, United States
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
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Dolan SB, Wittenauer R, Njoroge A, Onyango P, Owiso G, Shearer JC, Lober WB, Liu S, Puttkammer N, Rabinowitz P. Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows. JMIR Form Res 2023; 7:e39777. [PMID: 36927606 PMCID: PMC10019767 DOI: 10.2196/39777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries. OBJECTIVE We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual-data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs). METHODS We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient's total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models. RESULTS Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR's performance and ability to connect to the internet were particularly insightful about potential causes of delays. CONCLUSIONS We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology.
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Affiliation(s)
- Samantha B Dolan
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Rachel Wittenauer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anne Njoroge
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - George Owiso
- International Training and Education Center for Health, University of Washington, Nairobi, Kenya
| | | | - William B Lober
- Department of Global Health, University of Washington, Seattle, WA, United States
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Shan Liu
- Department of Industrial and Systems Engineering, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Peter Rabinowitz
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
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Dolan SB, Wittenauer R, Shearer JC, Njoroge A, Onyango P, Owiso G, Lober WB, Liu S, Puttkammer N, Rabinowitz P. Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability. JMIR Form Res 2023; 7:e39775. [PMID: 36917157 PMCID: PMC10131705 DOI: 10.2196/39775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. OBJECTIVE In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry's usability. METHODS Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. RESULTS Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1-ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2-confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3-identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4-make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. CONCLUSIONS We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users' workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users' needs and again after scale-up to ensure that interventions are suitable for all user settings.
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Affiliation(s)
- Samantha B Dolan
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Rachel Wittenauer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Anne Njoroge
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - George Owiso
- International Training and Education Center for Health, University of Washington, Nairobi, Kenya
| | - William B Lober
- Department of Global Health, University of Washington, Seattle, WA, United States.,Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Shan Liu
- Department of Industrial and Systems Engineering, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Peter Rabinowitz
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
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Kibira J, Kihungi L, Ndinda M, Wesangula E, Mwangi C, Muthoni F, Augusto O, Owiso G, Ndegwa L, Luvsansharav UO, Bancroft E, Rabinowitz P, Lynch J, Njoroge A. Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach. Antimicrob Resist Infect Control 2022; 11:56. [PMID: 35379327 PMCID: PMC8981833 DOI: 10.1186/s13756-022-01093-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hand hygiene (HH) is central in prevention of health care-associated infections. In low resource settings, models to improve HH compliance are needed. We implemented a continuous quality improvement (CQI) program targeting HH in two hospitals in Kenya.
Objective To determine the impact of the HH CQI program and identify factors associated with HH compliance between 2018 and 2019. Methods A CQI project targeting the improvement of hand hygiene was implemented, including training and mentorship. Data were collected monthly between April 2018 and December 2019 in Thika and Kitale Hospitals. Healthcare workers trained on Infection Prevention and Control (IPC) observed and recorded HH opportunities and subsequent compliance among staff, including nurses, clinicians, and auxiliary staff, using the World Health Organization’s “My Five Moments for Hand Hygiene” tool. Covariates were explored using mixed-effects logistic regression with random department-level intercepts. Results Hand hygiene compliance improved from 27% at baseline to 44% after 21 months. Indication/moment for HH was significantly associated with compliance. Adjusting for site, professional category and department, compliance was higher after a moment of body fluid exposure (aOR 1.43, 95% CI 1.17–1.74, p value < 0.001) and lower before an aseptic procedure (aOR 0.12, 95% CI 0.08–0.17, p value < 0.001) compared to after patient contact. Wearing of gloves often replaced proper HH in surgical departments, which although not significant, had lower compliance compared to departments for internal medicine (aOR 0.93, 95% CI 0.85–1.02). Adjusted HH compliance from all quarters improved from baseline, but comparing each quarter to the previous quarter, the improvement fluctuated over time. Conclusion Training and mentorship on the importance of HH for all moments is needed to improve overall HH compliance. CQI with regular monitoring and feedback of HH performance can be an effective approach in improving HH compliance in public hospitals in Kenya.
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Affiliation(s)
- Jemima Kibira
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Loyce Kihungi
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Mary Ndinda
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Evelyn Wesangula
- Department of Patient and Healthcare Worker Safety, Ministry of Health, Nairobi, Kenya
| | - Catherine Mwangi
- Infection Prevention and Control Department, Thika Level 5 Hospital, Kiambu, Kenya
| | - Faith Muthoni
- Infection Prevention and Control Department, Kitale County Referral Hospital, Trans-Nzoia, Kenya
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, USA
| | - George Owiso
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Linus Ndegwa
- Division of Global Health Protection (DGHP), Center for Global Health (CGH), US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Ulzii-Orshikh Luvsansharav
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Elizabeth Bancroft
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - John Lynch
- Department of Medicine, University of Washington, Seattle, USA
| | - Anne Njoroge
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya. .,Department of Global Health, University of Washington, Seattle, USA.
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Mogaka JN, Sharma M, Temu T, Masyuko S, Kinuthia J, Osoti A, Zifodya J, Nakanjako D, Njoroge A, Otedo A, Page S, Farquhar C. Prevalence and factors associated with hypertension among adults with and without HIV in Western Kenya. PLoS One 2022; 17:e0262400. [PMID: 35007291 PMCID: PMC8746744 DOI: 10.1371/journal.pone.0262400] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The burden of cardiovascular disease (CVD) is increasing in sub-Saharan Africa with untreated hypertension being a major contributing factor. Understanding the magnitude of the problem and risk factors associated with HIV and long-term antiretroviral therapy (ART) is critically important for designing effective programs for diagnosing and treating hypertension in Kenya. METHODS In this cross-sectional study, we enrolled 300 persons with HIV (PWH) on long term ART (≥6 months) and 298 HIV-negative adults seeking care at the Kisumu County Hospital between September 2017 and May 2018. Hypertension was defined as blood pressure of ≥140/90mmHg or a previous hypertension diagnosis. Multivariate regression was used to assess the association between hypertension and HIV adjusting for age, sex, and known CVD risk factors. RESULTS Overall prevalence of hypertension was 22%. PWH had a lower prevalence of hypertension than HIV-negative persons (16% vs 27% respectively; p<0.002). In multivariate analyses, persons with HIV were 37% less likely to have hypertension compared to HIV-negative individuals (adjusted prevalence ratio 0.63; 95% confidence interval: 0.46-0.86). Other factors that were associated with hypertension in all participants included older age >40 years, body mass index (BMI) >25 kg/m2 and low-density lipoproteins ≥130mg/dL. Among PWH, being older than 40 years and higher BMI >30 kg/m2 were associated with hypertension. CONCLUSION Prevalence of hypertension was high, affecting nearly one in every 4 adults, and associated with older age, higher BMI and high low-density lipoproteins. PWH on long-term ART had significantly lower prevalence of hypertension compared to HIV-negative individuals, potentially due to increased access to healthcare services and interaction with prevention messaging. Interventions to increase screening for and prevention of hypertension in the community for all adults are warranted.
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Affiliation(s)
- Jerusha Nyabiage Mogaka
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Tecla Temu
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Ministry of Health, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alfred Osoti
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Jerry Zifodya
- Department of Medicine, Section of Pulmonary, Critical Care, & Environmental Medicine, Tulane University, New Orleans, LA, United States of America
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | | | - Stephanie Page
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
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8
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Njoroge A, Augusto O, Page ST, Kigondu C, Oluka M, Puttkammer N, Farquhar C. Increased risk of prediabetes among virally suppressed adults with HIV in Central Kenya detected using glycated haemoglobin and fasting blood glucose. Endocrinol Diabetes Metab 2021; 4:e00292. [PMID: 34505404 PMCID: PMC8502220 DOI: 10.1002/edm2.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/24/2021] [Accepted: 06/19/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS As survival among people living with HIV (PLHIV) improves with universal HIV treatment, new strategies are needed to support management of co-morbidities like type 2 diabetes (T2D). We assessed prediabetes and T2D prevalence and risk factors using haemoglobin A1c (HbA1c) among PLHIV on antiretroviral therapy (ART) in Central Kenya. METHODS This cross-sectional study, conducted at a rural and urban site, enrolled PLHIV aged ≥35 years on ART for at least 5 years. HbA1c was assayed using Cobas b 101® , a point-of-care device. HbA1c levels ≥6.5% were considered diagnostic of T2D. For pre-diabetic HbA1c levels (5.7%-6.4%), participants were requested to return the following day for a fasting blood glucose (FBG) to rule out T2D. Risk factors were assessed using multivariable log-binomial regression. RESULTS Of the 600 completing study procedures, the prevalence of diabetes was 5% (30/600). Ten participants were known to have diabetes; thus, prevalence of newly diagnosed T2D was 3.4% (20/590). Prevalence of prediabetes (HbA1c 5.7%-6.4%) was 14.2% (84/590). Significant predictors of elevated HbA1c were increase in age (Prevalence ratio [PR]: 1.10, CI: 1.02, 1.18, p = .012), hypertension (PR: 1.43, CI: 1.07-2.3, p = .015), central adiposity (PR: 2.11, CI: 1.57-2.84, p < .001) and use of Efavirenz (PR: 2.09, CI: 1.48, 2.96, p < .001). CONCLUSION There is a high prevalence of prediabetes, a significant predictor of T2D, among PLHIV in Central Kenya. Point-of-care HbA1c may help identify PLHIV with prediabetes in a single screening visit and provide an opportunity for early intervention.
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Affiliation(s)
- Anne Njoroge
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Orvalho Augusto
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | | | - Margaret Oluka
- Department of Pharmacology and PharmacognosyUniversity of NairobiNairobiKenya
| | - Nancy Puttkammer
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Carey Farquhar
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
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9
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Ngure K, Trinidad SB, Beima-Sofie K, Kinuthia J, Matemo D, Kimemia G, Njoroge A, Achiro L, Pintye J, Mugo NR, Bukusi EA, Baeten JM, Heffron R, John-Stewart G, Kelley MC. Perceived Social Influences on Women's Decisions to use Medications not Studied in Pregnancy. A Qualitative Ethical Analysis of Preexposure Prophylaxis Implementation Research in Kenya. J Empir Res Hum Res Ethics 2021; 16:225-237. [PMID: 34133231 PMCID: PMC8261769 DOI: 10.1177/15562646211012296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Implementation research ethics can be particularly challenging when pregnant women have been excluded from earlier clinical stages of research given greater uncertainty about safety and efficacy in pregnancy. The evaluation of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) during pregnancy offered an opportunity to understand important ethical considerations and social influences shaping women's decisions to participate in the evaluation of PrEP and investigational drugs during pregnancy. We conducted interviews with women (n = 51), focus groups with male partners (five focus group discussions [FGDs]), interviews with health providers (n = 45), four FGDs with pregnant/postpartum adolescents and four FGDs with young women. Data were analyzed using thematic content analysis, including ethical aspects of the data. Our study reveals that women navigate a complex network of social influences, expectations, support, and gender roles, not only with male partners, but also with clinicians, family, and friends when making decisions about PrEP or other drugs that lack complete safety data during pregnancy.
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Affiliation(s)
- Kenneth Ngure
- Department of Community Health, 118985Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan B Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | | | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Research and Programs, 285569Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Matemo
- Department of Research and Programs, 285569Kenyatta National Hospital, Nairobi, Kenya
| | - Grace Kimemia
- Population Dynamic and Reproductive Health, 107883African Population and Health Research Center, Nairobi, Kenya
| | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Research and Programs, 285569Kenyatta National Hospital, Nairobi, Kenya
| | - Lillian Achiro
- Center for Microbiology Research, 118982Kenya Medical Research Institute Nairobi, Kenya
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Clinical Research, Kenya Medical Research Institute Nairobi, Kenya
| | - Elizabeth A Bukusi
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Microbiology Research, 118982Kenya Medical Research Institute Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Maureen C Kelley
- Wellcome Centre for Ethics & Humanities and Ethox Centre, Nuffield Department of Population Health, 6396University of Oxford, Oxford, UK
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10
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De Anda S, Njoroge A, Njuguna I, Dunbar MD, Abuna F, Macharia P, Betz B, Cherutich P, Bukusi D, Farquhar C, Katz DA. Predictors of First-Time and Repeat HIV Testing Among HIV-Positive Individuals in Kenya. J Acquir Immune Defic Syndr 2020; 85:399-407. [PMID: 33136736 DOI: 10.1097/qai.0000000000002469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite a doubling of HIV testing coverage in Kenya over the past decade, approximately 2 in 10 people with HIV remained unaware of their infection in 2018. HIV testing is most effective in identifying people with undiagnosed HIV through frequent and strategic testing in populations at high risk. An assessment of testing frequency and predictors of first-time and repeat testing is critical for monitoring effectiveness of testing strategies. METHODS We conducted a cross-sectional analysis of adults aged ≥18 years who tested HIV-positive at 4 HIV testing and counseling clinics in Kenya from February 2015 to February 2016. We categorized individuals based on testing history, used Wilcoxon rank-sum tests to assess differences in intervals between the most recent and current HIV test, and used log-binomial regression to determine characteristics associated with first-time and repeat testing. RESULTS Among 1136 people testing HIV-positive, 336 (30%) had never tested before and 800 (70%) had, of whom 208 (26%) had previously tested positive. Among previously negative repeat testers, the median intertest interval was 414 days in key/priority populations (interquartile range = 179-1072) vs. 538 in the general population (interquartile range = 228-1299) (P = 0.09). Compared with previously negative repeat testers, being a first-time tester was associated with being age ≥40 years [vs. 18-24; adjusted risk ratio = 1.67, 95% confidence interval (CI): 1.23 to 2.26], men (vs. women; adjusted risk ratio = 1.45, 95% CI: 1.21 to 1.71), and testing through provider-initiated testing and counseling (vs. client initiated; 1.19, 95% CI: 1.00 to 1.40). CONCLUSIONS There is a need to increase HIV testing among older individuals and men, increase testing frequency in key/priority populations, and maintain provider-initiated and facility-based testing to reach first-time testers.
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Affiliation(s)
- Sofia De Anda
- Department of Global Health, University of Washington, Seattle, WA
| | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, WA
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Irene Njuguna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Matthew D Dunbar
- Center for Demography and Ecology, University of Washington, Seattle, WA
| | - Felix Abuna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Bourke Betz
- Department of Global Health, University of Washington, Seattle, WA
| | | | - David Bukusi
- Voluntary Counseling and Testing (VCT) and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya; and
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Departments of Medicine University of Washington, Seattle, WA
| | - David A Katz
- Departments of Medicine University of Washington, Seattle, WA
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11
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Newman LP, Pagkas-Bather J, Njoroge A, Wamalwa D, Nduati R, Overbaugh J, Farquhar C. Virological failure in children living with HIV on antiretroviral therapy: correlates and predictive value of clinical measurements and CD4 cell count. Int J STD AIDS 2019; 30:1207-1213. [PMID: 31558136 DOI: 10.1177/0956462419871422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical correlates and CD4 cell count are used to predict HIV virological failure among children living with HIV in resource-limited settings, but there are limited data on their prediction of treatment failure compared to viral measurement. Using HIV viral load as a gold standard, sensitivity and specificity of longitudinal CD4 responses and clinical changes were defined in children living with HIV on antiretroviral therapy (ART) for ≥6 months in Kenya. Prevalence and correlates of virological failure were determined using log-binomial regression with robust standard error. Among 223 children who were followed for 12 months, median age in years at HIV diagnosis, ART initiation, and study enrollment were 3.3, 3.6, and 7.5, respectively. Older children at HIV diagnosis and ART initiation were less likely to experience virological failure. Immunological and clinical failure had low sensitivity (0 and 2%, respectively) to identify virological failure. Among those with virological failure, there was no indication from immunological markers and only two (2%) indicated with clinical markers. Clinical and immunological monitoring of HIV were insensitive and poor predictors of virological failure, emphasizing the importance of routine virological monitoring to inform ART treatment decisions for children living with HIV.
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Affiliation(s)
- Laura P Newman
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Dalton Wamalwa
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Ruth Nduati
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Julie Overbaugh
- Divisions of Public Health Sciences and Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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12
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Ghislain M, Byarugaba AA, Magembe E, Njoroge A, Rivera C, Román ML, Tovar JC, Gamboa S, Forbes GA, Kreuze JF, Barekye A, Kiggundu A. Stacking three late blight resistance genes from wild species directly into African highland potato varieties confers complete field resistance to local blight races. Plant Biotechnol J 2019; 17:1119-1129. [PMID: 30467980 PMCID: PMC6523587 DOI: 10.1111/pbi.13042] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/03/2018] [Accepted: 11/09/2018] [Indexed: 05/09/2023]
Abstract
Considered responsible for one million deaths in Ireland and widespread famine in the European continent during the 1840s, late blight, caused by Phytophthora infestans, remains the most devastating disease of potato (Solanum tuberosum L.) with about 15%-30% annual yield loss in sub-Saharan Africa, affecting mainly smallholder farmers. We show here that the transfer of three resistance (R) genes from wild relatives [RB, Rpi-blb2 from Solanum bulbocastanum and Rpi-vnt1.1 from S. venturii] into potato provided complete resistance in the field over several seasons. We observed that the stacking of the three R genes produced a high frequency of transgenic events with resistance to late blight. In the field, 13 resistant transgenic events with the 3R-gene stack from the potato varieties 'Desiree' and 'Victoria' grew normally without showing pathogen damage and without any fungicide spray, whereas their non-transgenic equivalent varieties were rapidly killed. Characteristics of the local pathogen population suggest that the resistance to late blight may be long-lasting because it has low diversity, and essentially consists of the single lineage, 2_A1, which expresses the cognate avirulence effector genes. Yields of two transgenic events from 'Desiree' and 'Victoria' grown without fungicide to reflect small-scale farm holders were estimated to be 29 and 45 t/ha respectively. This represents a three to four-fold increase over the national average. Thus, these late blight resistant potato varieties, which are the farmers' preferred varieties, could be rapidly adopted and bring significant income to smallholder farmers in sub-Saharan Africa.
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Affiliation(s)
| | | | | | | | | | - María Lupe Román
- International Potato CenterLimaPeru
- Present address:
Universidad Nacional Agraria La MolinaLima12Peru
| | - José Carlos Tovar
- International Potato CenterLimaPeru
- Present address:
Donald Danforth Plant Science Center975 North Warson RoadSt. LouisMissouri63132USA
| | | | | | | | - Alex Barekye
- Kachwekano Zonal Agricultural Research and Development InstituteKabaleUganda
| | - Andrew Kiggundu
- National Agriculture Research Laboratories (NARL)KampalaUganda
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13
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Pintye J, Beima-Sofie KM, Makabong'O PA, Njoroge A, Trinidad SB, Heffron RA, Baeten JM, Celum C, Matemo D, Kinuthia J, Kelley MC, John-Stewart GC. HIV-Uninfected Kenyan Adolescent and Young Women Share Perspectives on Using Pre-Exposure Prophylaxis During Pregnancy. AIDS Patient Care STDS 2018; 32:538-544. [PMID: 30036072 DOI: 10.1089/apc.2018.0058] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
To optimize scale-up of pre-exposure prophylaxis (PrEP) for pregnant women at risk of HIV in high HIV burden settings, implementation strategies must be developed that account for perceptions of PrEP in this unique population. Semistructured focus group discussions were conducted with 68 HIV-uninfected Kenyan pregnant and postpartum women without prior PrEP knowledge or experience. A qualitative descriptive analysis was performed, using a constant comparison approach, to identify key themes related to the values and rationale impacting potential PrEP use in pregnancy. Median age was 19.5 years and participants were either pregnant or had 1-2 children. Almost all (96%) were married or had a steady partner. Women felt pregnancy was a time of high HIV risk because they desired sex less frequently, which may lead their partners to have outside partnerships. This made PrEP an attractive HIV prevention option for themselves and their infants. Although women believed male partner behaviors influenced their HIV risk, many women perceived that male partners would react negatively, including becoming physically violent, if they discovered that women used PrEP. Clinicians were identified as potential facilitators of PrEP use who could explain PrEP to male partners on behalf of pregnant women. Women said that community-level stigma against HIV and potential for conflating PrEP with antiretroviral therapy (ART) would necessitate that PrEP use be discreet. Our results indicate the importance of addressing risk perception of women, concerns of male partners, HIV stigma, and benefits of PrEP for HIV prevention as programs are developed for pregnant women.
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Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Nursing, University of Washington, Seattle, Washington
| | | | | | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, Washington
| | - Susan Brown Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Renee A. Heffron
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington
- Kenyatta National Hospital, Nairobi, Kenya
| | - Maureen C. Kelley
- Nuffield Department of Population Health, The Ethox Center and Wellcome Center for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | - Grace C. John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
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14
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Newman LP, Njoroge A, Magaret A, Chohan BH, Gitomea VW, Wald A, Gorstein J, Overbaugh J, Wamalwa D, Maleche-Obimbo E, Nduati R, Farquhar C. Sustained Responses to Measles Revaccination at 24 Months in HIV-infected Children on Antiretroviral Therapy in Kenya. Pediatr Infect Dis J 2017; 36:1148-1155. [PMID: 28198789 PMCID: PMC5554743 DOI: 10.1097/inf.0000000000001572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are limited data on whether HIV-infected children in resource-limited countries who are receiving antiretroviral therapy (ART) are able to produce sustained, protective levels of measles antibody after multiple measles vaccinations. METHODS We administered an additional measles vaccine to HIV-infected children 15 months to 12 years of age receiving ART in Nairobi, Kenya. Measles antibody concentrations were determined by enzyme-linked immunosorbent assay at enrollment, 1 month, 12 months and 24 months post revaccination. RESULTS At enrollment, 125 (54%) of 232 study participants had protective concentrations of measles antibody. Measles seropositivity increased to 98% of all children at 1 month post revaccination but decreased to 71% at 12 months and 60% at 24 months post revaccination. Measles seroconversion and sustained measles seropositivity among those who were measles seronegative at enrollment was 25% at 24 months post revaccination. In this group, 39% of children with <50 copies/mL plasma HIV RNA measles seroconverted compared to 4% of children with plasma HIV RNA ≥1000 copies/mL (P = 0.018). CONCLUSIONS Measles revaccination can result in a sustained antibody response in a subset of HIV-infected children receiving ART, especially among those with HIV suppression.
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Affiliation(s)
- Laura P Newman
- From the *Department of Global Health, University of Washington, Seattle, Washington; †Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya; ‡Department of Laboratory Medicine, University of Washington, §Department of Biostatistics, University of Washington, ¶Division of Vaccine and Infectious Disease, Fred Hutchinson Cancer Research Center, ‖Department of Epidemiology, University of Washington, **Department of Medicine, University of Washington, ††Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and ‡‡Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; and §§Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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15
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Njoroge A, Guthrie BL, Bosire R, Wener M, Kiarie J, Farquhar C. Low HDL-cholesterol among HIV-1 infected and HIV-1 uninfected individuals in Nairobi, Kenya. Lipids Health Dis 2017; 16:110. [PMID: 28599673 PMCID: PMC5466788 DOI: 10.1186/s12944-017-0503-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/29/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) is associated with dyslipidemia yet little is known about the burden of dyslipidemia in the absence of ART in sub-Saharan Africa. We compared the prevalence and risk factors for dyslipidemia among HIV-infected ART-naïve adults and their uninfected partners in Nairobi, Kenya. METHODS Non-fasting total cholesterol (TC) and high density lipoprotein cholesterol (HDL) levels were measured by standard lipid spectrophotometry on thawed plasma samples obtained from HIV-infected participants and their uninfected partners. Dyslipidemia, defined by high TC (>200 mg/dl) or low HDL (<40 mg/dl) was compared between HIV-infected and uninfected men and women. RESULTS Among 196 participants, median age was 32 years [IQR: 23-41]. Median CD4 count among the HIV-infected was 393 cells/ μl (IQR: 57-729) and 90% had a viral load >1000 copies/ml. Mean TC and HDL were comparable for HIV-infected and uninfected participants. Prevalence of dyslipidemia was 83.8% vs 78.4% (p = 0.27). Among the HIV-infected, those with a viral load >1000 copies/ml were 1.5-fold more likely to have dyslipidemia compared to those with ≤1000 copies/ml (adjusted prevalence ratio [aPR] 1.5, 95% CI: 1.22-30.99, p = 0.02). BMI, age, gender, blood pressure and smoking were not significantly associated with dyslipidemia. CONCLUSIONS Among ART-naïve HIV-infected adults, high viral load and low CD4 cell count were independent predictors of dyslipidemia, underscoring the importance of early initiation of ART for viral suppression.
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Affiliation(s)
- Anne Njoroge
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- University of Washington, Seattle, WA USA
| | - B. L. Guthrie
- University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Rose Bosire
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark Wener
- Department of Medicine, University of Washington, Seattle, WA USA
| | - James Kiarie
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Carey Farquhar
- University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
- Department of Medicine, University of Washington, Seattle, WA USA
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16
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Means AR, Phillips DE, Lurton G, Njoroge A, Furere SM, Liu R, Hassan WM, Dai X, Augusto O, Cherutich P, Ikilezi G, Soi C, Xu D, Kemp CG. The role of implementation science training in global health: from the perspective of graduates of the field's first dedicated doctoral program. Glob Health Action 2016; 9:31899. [PMID: 27846928 PMCID: PMC5110555 DOI: 10.3402/gha.v9.31899] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 11/14/2022] Open
Abstract
Bridging the ‘know-do gap’ is an enormous challenge for global health practitioners. They must be able to understand local health dynamics within the operational and social contexts that engender them, test and adjust approaches to implementation in collaboration with communities and stakeholders, interpret data to inform policy decisions, and design adaptive and resilient health systems at scale. These skills and methods have been formalized within the nascent field of Implementation Science (IS). As graduates of the world's first PhD program dedicated explicitly to IS, we have a unique perspective on the value of IS and the training, knowledge, and skills essential to bridging the ‘know-do gap’. In this article, we describe the philosophy and curricula at the core of our program, outline the methods vital to IS in a global health context, and detail the role that we believe IS will increasingly play in global health practice. At this junction of enormous challenges and opportunities, we believe that IS offers the necessary tools for global health professionals to address complex problems in context and raises the bar of success for the global health programs of the future.
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Affiliation(s)
- Arianna R Means
- Department of Global Health, University of Washington, Seattle, WA, USA;
| | - David E Phillips
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Grégoire Lurton
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Sabine M Furere
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rong Liu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Wisal M Hassan
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Xiaochen Dai
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Peter Cherutich
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Gloria Ikilezi
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Caroline Soi
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Dong Xu
- Department of Global Health, University of Washington, Seattle, WA, USA
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17
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Njoroge A, Munene KE. SCALING UP NON-COMMUNICABLE DISEASE CONTROL: LESSONS TO BE LEARNT FROM THE INFECTIOUS DISEASE PARADIGM IN KENYA. East Afr Med J 2015; 92:608-611. [PMID: 28811676 PMCID: PMC5554602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Non-communicable diseases (NCD) are emerging as the leading cause of morbidity & mortality globally, with the greatest rise in incidence of cardiovascular disease cases observed in Sub-Saharan Africa. This is in addition to the heavy burden of infectious diseases already present in this setting. Describing the cross-cutting epidemiology of NCDs and infectious diseases with focus on the interaction between tuberculosis and diabetes mellitus, HIV and cardiovascular disease, HIV and cervical cancer as well as assessing the disparities in funding and service delivery systems between NCDs and infectious diseases; we review this rising double burden of infectious and non-infectious diseases and propose four lessons that can be learnt from the HIV response and adapted to inform the scale up of NCD control in Kenya which are also applicable in other African countries.
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Affiliation(s)
- A Njoroge
- Kenyatta National Hospital, Research and Programs Department
| | - K E Munene
- University of Nairobi, School of Dentistry, Department of Preventive and Community Dentistry
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Buechler MB, Newman LP, Chohan BH, Njoroge A, Wamalwa D, Farquhar C. T cell anergy and activation are associated with suboptimal humoral responses to measles revaccination in HIV-infected children on anti-retroviral therapy in Nairobi, Kenya. Clin Exp Immunol 2015; 181:451-6. [PMID: 25739813 DOI: 10.1111/cei.12619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 02/03/2023] Open
Abstract
HIV-infected children are less capable of mounting and maintaining protective humoral responses to vaccination against measles compared to HIV-uninfected children. This poses a public health challenge in countries with high HIV burdens. Administration of anti-retroviral therapy (ART) and revaccinating children against measles is one approach to increase measles immunity in HIV-infected children, yet it is not effective in all cases. Immune anergy and activation during HIV infection are factors that could influence responses to measles revaccination. We utilized a flow cytometry-based approach to examine whether T cell anergy and activation were associated with the maintenance of measles-specific immunoglobulin (Ig)G antibodies generated in response to measles revaccination in a cohort of HIV-infected children on ART in Nairobi, Kenya. Children who sustained measles-specific IgG for at least 1 year after revaccination displayed significantly lower programmed cell death 1 (PD-1) surface expression on CD8(+) T cells on a per-cell basis and exhibited less activated CD4(+) T cells compared to those unable to maintain detectable measles-specific antibodies. Children in both groups were similar in age and sex, CD4(+) T cell frequency, duration of ART treatment and HIV viral load at enrolment. These data suggest that aberrant T cell anergy and activation are associated with the impaired ability to sustain an antibody response to measles revaccination in HIV-infected children on ART.
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Affiliation(s)
- M B Buechler
- Immunology Program, Benaroya Research Institute at Virginia Mason, Seattle, WA, USA.,Department of Immunology, University of Washington, Seattle, WA, USA
| | | | - B H Chohan
- Department of Global Health, University of Washington, Seattle, WA, USA.,Kenya Medical Research Institute
| | - A Njoroge
- Research and Programs Department, Kenyatta National Hospital
| | - D Wamalwa
- Department of Pediatrics, University of Nairobi, Nairobi, Kenya
| | - C Farquhar
- Department of Epidemiology.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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Affiliation(s)
- A Njoroge
- Eastern Deanery AIDS Relief Programme, Nairobi, Kenya
| | - S Cassidy
- Freelance journalist, Cape Town, South Africa
| | - V Williams
- International Council of Nurses, Geneva, Switzerland
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Odhiambo J, Kizito W, Njoroge A, Wambua N, Nganga L, Mburu M, Mansoer J, Marum L, Phillips E, Chakaya J, De Cock KM. Provider-initiated HIV testing and counselling for TB patients and suspects in Nairobi, Kenya. Int J Tuberc Lung Dis 2008; 12:63-68. [PMID: 18302825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING Integrated tuberculosis (TB) and human immunodeficiency virus (HIV) services in a resource-constrained setting. OBJECTIVE Pilot provider-initiated HIV testing and counselling (PITC) for TB patients and suspects. DESIGN Through partnerships, resources were mobilised to establish and support services. After community sensitisation and staff training, PITC was introduced to TB patients and then to TB suspects from December 2003 to December 2005. RESULTS Of 5457 TB suspects who received PITC, 89% underwent HIV testing. Although not statistically significant, TB suspects with TB disease had an HIV prevalence of 61% compared to 63% for those without. Of the 614 suspects who declined HIV testing, 402 (65%) had TB disease. Of 2283 patients referred for cotrimoxazole prophylaxis, 1951 (86%) were enrolled, and of 1727 patients assessed for antiretroviral treatment (ART), 1618 (94%) were eligible and 1441 (83%) started treatment. CONCLUSIONS PITC represents a paradigm shift and is feasible and acceptable to TB patients and TB suspects. Clear directives are nevertheless required to change practice. When offered to TB suspects, PITC identifies large numbers of persons requiring HIV care. Community sensitisation, staff training, multitasking and access to HIV care contributed to a high acceptance of HIV testing. Kenya is using this experience to inform national response and advocate wide PITC implementation in settings faced with the TB-HIV epidemic.
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Affiliation(s)
- J Odhiambo
- United States Centers for Disease Control and Prevention, Nairobi, Kenya.
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