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Aluisio AR, Smith-Sreen J, Offorjebe A, Maina W, Pirirei S, Kinuthia J, Bukusi D, Waweru H, Bosire R, Ojuka DK, Eastment MC, Katz DA, Mello MJ, Farquhar C. Implementation and Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) Program in Nairobi, Kenya: A Quasi-Experimental Prospective Study. medRxiv 2024:2024.04.03.24305277. [PMID: 38633813 PMCID: PMC11023650 DOI: 10.1101/2024.04.03.24305277] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Persons seeking emergency injury care are often from underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed using setting specific data and utilizes resource reorganization, services integration and HIV sensitization to promote ED-HTS. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and those never previously HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June - 20 August 2023). Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains. Results All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR=1.31, 95% CI:1.21-1.43; p<0.001) with a 62.9% relative increase in HIV self-test kit provision. Among 605 patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR=11.2, 95%CI:6.9-18.1; p<0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR=13.8, 95%CI:5.5-28.7, p<0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16-weeks post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation. Conclusions The HEATED program increased ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons, already in contact with health systems.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | | | - Agatha Offorjebe
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | | | | | - John Kinuthia
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Daniel K. Ojuka
- Department of Surgery, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
| | - McKenna C. Eastment
- Department of Global Health, University of Washington, Seattle, US
- Department of Medicine, University of Washington, Seattle, US
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, US
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, US
- Department of Medicine, University of Washington, Seattle, US
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Aluisio AR, Sugut J, Kinuthia J, Bosire R, Ochola E, Ngila B, Ojuka DK, Lee JA, Maingi A, Guthrie KM, Liu T, Mugambi M, Katz DA, Farquhar C, Mello MJ. Assessment of standard HIV testing services delivery to injured persons seeking emergency care in Nairobi, Kenya: A prospective observational study. PLOS Glob Public Health 2022; 2:e0000526. [PMID: 36962519 PMCID: PMC10021732 DOI: 10.1371/journal.pgph.0000526] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Emergency departments (EDs) in Africa are contact points for key groups for HIV testing services (HTS) but understanding of ED-testing delivery is limited which may impeded program impacts. This study evaluated the offering and uptake of standard HTS among injured persons seeking ED care at Kenyatta National Hospital (KNH) in Nairobi, Kenya. An ED population of adult injured persons was prospectively enrolled (1 March-25 May 2021) and followed through ED disposition. Participants requiring admission were followed through hospital discharge and willing participants were contacted at 28-days for follow up. Data on population characteristics and HTS were collected by personnel distinct from clinicians responsible for standard HTS. Descriptive analyses were performed and prevalence values with 95% confidence intervals (CI) were calculated for HIV parameters. The study enrolled 646 participants. The median age was 29 years with the majority male (87.8%). Most ED patients were discharged (58.9%). A prior HIV diagnosis was reported by 2.3% of participants and 52.7% reported their last testing as >6 months prior. Standard ED-HTS were offered to 49 or 8.6% of participants (95% CI: 5.8-9.9%), among which 89.8% accepted. For ED-tested participants 11.4% were newly diagnosed with HIV (95% CI: 5.0-24.0%). Among 243 participants admitted, testing was offered to 6.2% (95% CI: 3.9-9.9%), with 93.8% accepting. For admitted participants tested 13.3% (95% CI: 4.0-35.1%) were newly diagnosed (all distinct from ED cases). At 28-day follow up an additional 22 participants reported completing testing since ED visitation, with three newly diagnosed. During the full follow-up period the HIV prevalence in the population tested was 10.3% (95% CI: 5.3-19.0%); all being previously undiagnosed. Offering of standard HTS was infrequent, however, when offered, uptake and identification of new HIV diagnoses were high. These data suggest that opportunities exist to improve ED-HTS which could enhance identification of undiagnosed HIV.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Janet Sugut
- Department of Accident and Emergency, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric Ochola
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Beatrice Ngila
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel K. Ojuka
- Department of Surgery, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
| | - J. Austin Lee
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Alice Maingi
- Department of Dermatology, Kenyatta National Hospital, Nairobi, Kenya
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States of America
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | | | - David A. Katz
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America
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Bandyopadhyay S, Baticulon RE, Kadhum M, Alser M, Ojuka DK, Badereddin Y, Kamath A, Parepalli SA, Brown G, Iharchane S, Gandino S, Markovic-Obiago Z, Scott S, Manirambona E, Machhada A, Aggarwal A, Benazaize L, Ibrahim M, Kim D, Tol I, Taylor EH, Knighton A, Bbaale D, Jasim D, Alghoul H, Reddy H, Abuelgasim H, Saini K, Sigler A, Abuelgasim L, Moran-Romero M, Kumarendran M, Jamie NA, Ali O, Sudarshan R, Dean R, Kissyova R, Kelzang S, Roche S, Ahsan T, Mohamed Y, Dube AM, Gwini GP, Gwokyala R, Brown R, Papon MRKK, Li Z, Ruzats SS, Charuvila S, Peter N, Khalidy K, Moyo N, Alser O, Solano A, Robles-Perez E, Tariq A, Gaddah M, Kolovos S, Muchemwa FC, Saleh A, Gosman A, Pinedo-Villanueva R, Jani A, Khundkar R. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. BMJ Glob Health 2020; 5:e003097. [PMID: 33277297 PMCID: PMC7722361 DOI: 10.1136/bmjgh-2020-003097] [Citation(s) in RCA: 340] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/19/2020] [Accepted: 10/09/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic. DESIGN Systematic review. METHODS Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence. OUTCOME MEASURES Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed. RESULTS A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). CONCLUSIONS COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Ronnie E Baticulon
- Philippine General Hospital, University of the Philippines Manila College of Medicine, Manila, Metro Manila, The Philippines
| | - Murtaza Kadhum
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Muath Alser
- Kasr Al Ainy School of Medicine, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Daniel K Ojuka
- Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Yara Badereddin
- Faculty of Pharmacy, Al Azhar University-Gaza, Gaza, State of Palestine
| | - Archith Kamath
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Sai Arathi Parepalli
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Grace Brown
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Sara Iharchane
- Dipartimento di medicina clinica e sperimentale, University of Insubria, Varese, Lombardia, Italy
| | - Sofia Gandino
- Dipartimento di medicina clinica e sperimentale, University of Insubria, Varese, Lombardia, Italy
| | - Zara Markovic-Obiago
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Samuel Scott
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Emery Manirambona
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Asif Machhada
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Aditi Aggarwal
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Lydia Benazaize
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Mina Ibrahim
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - David Kim
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Isabel Tol
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Elliott H Taylor
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Alexandra Knighton
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Dorothy Bbaale
- Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
| | - Duha Jasim
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Heba Alghoul
- Islamic University of Gaza, Gaza, State of Palestine
| | - Henna Reddy
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Hibatullah Abuelgasim
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Kirandeep Saini
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Leenah Abuelgasim
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Mario Moran-Romero
- Department of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez, National Autonomous University of Mexico, Mexico City, Mexico
| | - Mary Kumarendran
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Omaima Ali
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Raghav Sudarshan
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Riley Dean
- University of California San Diego, La Jolla, California, USA
| | - Rumi Kissyova
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Sonam Kelzang
- Gelephu Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sophie Roche
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Tazin Ahsan
- Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Yethrib Mohamed
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Andile Maqhawe Dube
- National University of Science and Technology Faculty of Medicine, Bulawayo, Zimbabwe
| | - Grace Paida Gwini
- National University of Science and Technology Faculty of Medicine, Bulawayo, Zimbabwe
| | - Rashidah Gwokyala
- Gulu University Faculty of Medicine, Gulu, Uganda
- Oxford Brookes University, Oxford, Oxfordshire, UK
| | - Robin Brown
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Zoe Li
- Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | | | - Somy Charuvila
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Noel Peter
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Nkosikhona Moyo
- National University of Science and Technology Faculty of Medicine, Bulawayo, Zimbabwe
| | - Osaid Alser
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
- Harvard Medical School, Boston, Massachusetts, USA
| | - Arielis Solano
- ConnectMed International, Dominican Republic, Dominican Republic
| | | | - Aiman Tariq
- Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Mariam Gaddah
- Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
| | - Spyros Kolovos
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Faith C Muchemwa
- Parirenyatwa Hospital, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Abdullah Saleh
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Office of Global Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Gosman
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Rafael Pinedo-Villanueva
- Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, Hampshire, UK
| | - Anant Jani
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Roba Khundkar
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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