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O’Bryan G, Chirairo H, Munyayi F, Ensminger A, Barnabee G, Dzinotyiweyi E, Mwandingi L, Ashipala L, Forster N, O’Malley G, Golden MR. Assisted Partner Notification Services in Namibia: Comparison of Case-Finding in Persons With New and Previously Diagnosed Human Immunodeficiency Virus, and Success as a Platform for PrEP Referral. Sex Transm Dis 2024; 51:214-219. [PMID: 38412468 PMCID: PMC10901442 DOI: 10.1097/olq.0000000000001922] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Assisted partner notification services (APS) are widely implemented throughout sub-Saharan Africa. The effectiveness of APS among persons with previously diagnosed human immunodeficiency virus (HIV) infection is uncertain, and there are few published data on the success of integrating referrals for HIV preexposure prophylaxis (PrEP) into APS. METHODS Staff in 22 Namibian Ministry of Health and Social Service clinics offered APS to patients newly and previously diagnosed with HIV (index cases [ICs]) between October 2019 and June 2021. Counselors used a structured interview guide to elicit ICs' sex partners and biological children and assisted ICs to arrange testing of contacts. Contacts testing HIV-positive were linked to HIV services and those 14 years or older testing negative were offered PrEP. The primary outcome was the case-finding index (contacts testing HIV-positive ÷ ICs receiving APS). RESULTS Staff provided APS to 1222 (78%) of 1557 newly diagnosed ICs eliciting 1155 sex partners and 649 biological children. Among 280 previously diagnosed ICs, 279 sex partners and 158 biological children were elicited. The case-finding index was higher among ICs with newly diagnosed HIV compared with previously diagnosed HIV (0.14 vs 0.09, P = 0.46), though this difference was not statistically significant. Most sex partners testing HIV-negative were initiated on PrEP (67% in sex partners from newly diagnosed ICs; 74% in sex partners from previously diagnosed ICs). CONCLUSIONS Assisted partner notification services successfully identified sex partners and biological children with undiagnosed HIV infection when provided to both newly and previously diagnosed ICs. Integration of referral to PrEP resulted in many HIV-negative partners initiating PrEP.
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Affiliation(s)
- Gillian O’Bryan
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Harugumi Chirairo
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Farai Munyayi
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Alison Ensminger
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Gena Barnabee
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | - Laimi Ashipala
- Ministry of Health and Social Services (MHSS), Windhoek, Namibia
| | - Norbert Forster
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Matthew R. Golden
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Center for AIDS and STD, University of Washington, USA
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Wagner AD, Beima-Sofie K, Awuor M, Owade W, Neary J, Dettinger JC, Pintye J, Abuna F, Lagat H, Weiner BJ, Kohler P, Kinuthia J, John-Stewart G, O’Malley G. Implementation determinants and strategies in integration of PrEP into maternal and child health and family planning services: experiences of frontline healthcare workers in Kenya. Front Reprod Health 2023; 5:1205925. [PMID: 37799494 PMCID: PMC10548203 DOI: 10.3389/frph.2023.1205925] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Background Delivery of PrEP to adolescent girls and young women (AGYW) and to pregnant women through maternal and child health (MCH) and family planning (FP) clinics is scaling up in Kenya. Evaluation of implementation challenges and strategies is critical to optimize delivery. Methods We conducted focus group discussions (FGDs) with healthcare workers (HCWs) in MCH and FP clinics offering PrEP in a large implementation project in Kisumu, Kenya. Discussion guides were based on the Consolidated Framework for Implementation Research (CFIR). FGDs were audio recorded and transcribed. Directed content analysis was used to identify implementation challenges and strategies to overcome them. Results Fifty HCWs from 26 facilities participated in 8 FGDs. HCWs believed PrEP integration was appropriate because it met the needs of AGYW and pregnant women by providing a female-controlled prevention strategy and aligned with policy priorities of elimination of vertical HIV transmission. They were universally accepting of PrEP provision, especially through MCH clinics, noting the relative advantage of this approach because it: (1) enabled high coverage, (2) harmonized PrEP and MCH visits, and (3) minimized stigma compared to PrEP offered through HIV care clinics. However, HCWs noted implementation challenges affecting feasibility and adoption including: (1) increased workload and documentation burden amid workforce shortages, (2) insufficient health care worker knowledge (3) multiple implementing partners with competing priorities (4) drug and documentation form stockouts. HCWs employed various implementation strategies to overcome challenges, including task shifting from nurses to HIV testing providers, patient flow modifications (e.g., fast-tracking PrEP clients to reduce wait times), PrEP demand generation and myth clarification during health talks, provider education, dedicated PrEP delivery rooms, and coordination with adolescent-friendly services. Additional suggested strategies to improve PrEP integration included community education to increase broader PrEP awareness and enable shorter counseling sessions, and task-shifting data entry and client risk assessments. Conclusions HCWs were enthusiastic about the appropriateness and acceptability of integrating PrEP services into MCH and FP clinics but noted challenges to adoption and feasibility. Strategies to address challenges focused on improving provider time and space constraints, and increasing provider and client knowledge.
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Affiliation(s)
- Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | | | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Julia C. Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Felix Abuna
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Harison Lagat
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Departments of Pediatrics and Medicine, University of Washington, Seattle, WA, United States
| | - Gabrielle O’Malley
- Department of Global Health, University of Washington, Seattle, WA, United States
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Barnabee G, Billah I, Ndeikemona L, Silas L, Ensminger A, MacLachlan E, Korn AK, Mawire S, Fischer-Walker C, Ashipala L, Forster N, O’Malley G, Velloza J. PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia. PLoS One 2023; 18:e0289353. [PMID: 37647257 PMCID: PMC10468070 DOI: 10.1371/journal.pone.0289353] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/17/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) face barriers in accessing clinic-based HIV pre-exposure prophylaxis (PrEP) services and community-based models are a proposed alternative. Evidence from such models, however, is limited. We evaluated PrEP service coverage, uptake, and early persistence among AGYW receiving services through community and hybrid models in Namibia. METHODS We analyzed routine data for AGYW aged 15-24 who initiated PrEP within HIV prevention programming. PrEP was delivered via three models: community-concierge (fully community-based services with individually-tailored refill locations), community-fixed (community-based initiation and refills delivered by community providers on a set schedule at fixed sites), and hybrid community-clinic (community-based initiation and referral to clinics for refills delivered by clinic providers). We examined proportions of AGYW engaged in services along a programmatic PrEP cascade, overall and by model, and assessed factors associated with PrEP uptake and early persistence (refill within 15-44 days after initiation) using multivariable generalized estimating equations. RESULTS Over 10-months, 7593 AGYW participated in HIV prevention programming. Of these, 7516 (99.0%) received PrEP education, 6105 (81.2%) received HIV testing services, 6035 (98.9%) tested HIV-negative, and 2225 (36.9%) initiated PrEP. Of the 2047 AGYW expected for PrEP refill during the study period, 254 (12.4%) persisted with PrEP one-month after initiation. Structural and behavioral HIV risk factors including early school dropout, food insecurity, inconsistent condom use, and transactional sex were associated with PrEP uptake. AGYW who delayed starting PrEP were 2.89 times more likely to persist (95% confidence interval (CI): 1.52-5.46) and those receiving services via the community-concierge model were 8.7 times (95% CI: 5.44-13.9) more likely to persist (compared to the hybrid model). CONCLUSION Community-based models of PrEP service delivery to AGYW can achieve high PrEP education and HIV testing coverage and moderate PrEP uptake. AGYW-centered approaches to delivering PrEP refills can promote higher persistence.
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Affiliation(s)
- Gena Barnabee
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Idel Billah
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | | | - Lukas Silas
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Alison Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Ellen MacLachlan
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Abigail K. Korn
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | | | | | - Laimi Ashipala
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Jennifer Velloza
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
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Agathis NT, Annor FB, Xu L, Swedo E, Chiang L, Coomer R, Hegle J, Patel P, Forster N, O’Malley G, Ensminger AL, Kamuingona R, Andjamba H, Nshimyimana B, Manyando M, Massetti GM. Strong Father-Child Relationships and Other Positive Childhood Experiences, Adverse Childhood Experiences, and Sexual Risk Factors for HIV among Young Adults Aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study. Int J Environ Res Public Health 2023; 20:6376. [PMID: 37510608 PMCID: PMC10378761 DOI: 10.3390/ijerph20146376] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey and sex-stratified multivariable models, we assessed the associations between four different positive childhood experiences (PCEs) and having ≥3 adverse childhood experiences (ACEs), including ≥3 ACE-PCE interaction terms, and seven sexual risk factors for HIV acquisition among young adults aged 19-24 years. One PCE, having a strong father-child relationship, was inversely associated with two risk factors among women (lifetime transactional sex (OR, 0.4; 95% CI, 0.2-0.7) and recent age-disparate sexual relationships (OR, 0.3; 95% CI, 0.2-0.5)), and significantly interacted with having ≥3 ACEs for three risk factors among women (not knowing a partner's HIV status, infrequently using condoms, and ever having an STI) and one among men (having multiple sexual partners in the past year). The other PCEs were significantly associated with ≤1 HIV risk factor and had no significant interaction terms. Strong father-child relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on HIV risk among young adults in Namibia.
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Affiliation(s)
- Nickolas T. Agathis
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Francis B. Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Likang Xu
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Elizabeth Swedo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Laura Chiang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Rachel Coomer
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Private Bag, Windhoek 12029, Namibia
| | - Jennifer Hegle
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Pragna Patel
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Alison L. Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rahimisa Kamuingona
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Helena Andjamba
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Brigitte Nshimyimana
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Molisa Manyando
- US Agency for International Development, Washington, DC 20004, USA
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Njuguna I, Moraa H, Mugo C, Mbwayo A, Nyapara F, Aballa C, Wagner AD, Wamalwa D, John-Stewart G, Inwani I, O’Malley G. 'They should show them love even if their status of being HIV positive is known': Youth and caregiver stigma experience and strategies to end HIV stigma in schools. Trop Med Int Health 2023; 28:466-475. [PMID: 37177902 PMCID: PMC10278085 DOI: 10.1111/tmi.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE HIV stigma and discrimination is widespread in sub-Saharan Africa and is associated with poor clinical outcomes. Schools play a critical role in the life of youth and have been identified as a potentially stigmatising environment. We sought to explore school HIV stigma drivers, facilitators, manifestations and outcomes among youth living with HIV (YLH) as well as potential stigma reduction interventions in Kenya. METHODS Semi-structured in-depth qualitative interviews with 28 school-attending YLH aged 14-19 years and 24 caregivers of YLH were analysed using directed content analysis. Results were summarised using the Health and Stigma Framework. RESULTS Drivers and facilitators of HIV stigma in the school environment included misconceptions about HIV transmission, HIV treatment outcomes and long-term overall health of people living with HIV. HIV stigma manifested largely as gossip, isolation and loss of friendships. Fear of HIV stigma or experienced stigma resulted in poor adherence to antiretroviral treatment-particularly among YLH in boarding schools-and poor mental health. Stigma also impacted school choice (boarding vs. day school) and prevented HIV disclosure to schools which was necessary for optimal support for care. Proposed interventions to address HIV stigma in schools included HIV education, psychosocial support for YLH, support for HIV disclosure to schools while ensuring confidentiality and building YLH resilience. CONCLUSION There is an urgent need to develop interventions to address HIV stigma in schools to ensure optimised health and social outcomes for YLH. Future studies to understand the most effective and efficient interventions are needed.
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Affiliation(s)
- Irene Njuguna
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Hellen Moraa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Florence Nyapara
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Calvins Aballa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anjuli D. Wagner
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Epidemiology, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Medicine, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Pediatrics, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Irene Inwani
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Gabrielle O’Malley
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
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Rousseau E, Wu L, Heffron R, Baeten JM, Celum CL, Travill D, Delany-Moretlwe S, Bekker LG, Bukusi E, Omollo V, van der Straten A, O’Malley G, Haberer JE, Morton JF, Johnson RE, Roberts ST. Association of sexual relationship power with PrEP persistence and other sexual health outcomes among adolescent and young women in Kenya and South Africa. Front Reprod Health 2023; 5:1073103. [PMID: 37325240 PMCID: PMC10266091 DOI: 10.3389/frph.2023.1073103] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Gendered power inequalities impact adolescent girls' and young women's (AGYW) sexual and reproductive health (SRH) outcomes. We investigated the influence of sexual relationship power on AGYW's SRH outcomes, including HIV pre-exposure prophylaxis (PrEP) persistence. Methods The POWER study in Kisumu, Kenya, and Cape Town and Johannesburg, South Africa provided PrEP to 2,550 AGYW (aged 16-25). AGYW's perceived power in their primary sexual relationship was measured among the first 596 participants enrolled using the Sexual Relationship Power Scale's (SRPS) relationship control sub-scale. Multivariable regression was used to test for (1) key sociodemographic and relationship characteristics associated with relationship power; and (2) the association of relationship power with SRH outcomes including PrEP persistence. Results In this cohort, the mean SRPS score was 2.56 (0.49), 542 (90.9%) initiated PrEP; 192 (35.4%) persisted with PrEP at 1 month of which 46 (24.0% of 192) persisted at 6 months. SRPS were significantly lower among AGYW who cohabited with their sex partner (-0.14, 95% CI: -0.24 to -0.04, p = 0.01), or had ≥1 sex partner (-0.10, 95% CI: -0.19 to -0.00, p = 0.05). AGYW with lower SRPS were more likely to not know their partner's HIV status (aOR 2.05, 95% CI: 1.27 to 3.33, p < 0.01), but SRPS was not associated with PrEP persistence, STI infection, condom, or hormonal contraception use. Discussion AGYW's reasons for initiating PrEP and reasons for continuously using PrEP may be different. While low relationship power was associated with perceived HIV vulnerability, AGYW's PrEP persistence may be influenced by more than relationship power.
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Affiliation(s)
- Elzette Rousseau
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Linxuan Wu
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Renee Heffron
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Jared M. Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
- Gilead Sciences, Inc., Seattle, WA, United States
| | - Connie L. Celum
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Danielle Travill
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | | | - Ariane van der Straten
- Department of Medicine, Centre for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
- Astra Consulting, Kensington, CA, United States
| | - Gabrielle O’Malley
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Jessica E. Haberer
- Harvard Medical School, Harvard University, Boston, MA, United States
- Centre for Global Health, Massachusetts General Hospital, Boston, MA, United States
| | - Jennifer F. Morton
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Rachel E. Johnson
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Sarah T. Roberts
- RTI International, Women’s Global Health Imperative (WGHI), Berkeley, CA, United States
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Healy E, O’Malley G, Mugo C, Kaggiah A, Seeh D, Muriithi A, Lopez AR, Kumar M, Guthrie B, Moreno M, John-Stewart G, Inwani I, Ronen K. "Whenever you need support, you first turn to the group": motivations and functions of WhatsApp groups for youth living with HIV. AIDS Care 2023; 35:437-446. [PMID: 35761786 PMCID: PMC9792620 DOI: 10.1080/09540121.2022.2088680] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/07/2022] [Indexed: 12/30/2022]
Abstract
Social support is a critical component of achieving positive health outcomes for youth living with HIV (YLWH). Mobile health (mHealth) has significant potential for providing social support to YLWH. However, little is known about the domains of social support most needed by YLWH which mHealth interventions might address. Drawing on the spontaneous creation of WhatsApp support groups by YLWH in Nairobi, Kenya, we characterized Kenyan YLWH's social support needs and potential roles of social media groups in meeting them. We conducted interviews and focus-groups with 68 YLWH, 24 caregivers and 20 healthcare workers, and observed two YLWH-led WhatsApp groups for 6 weeks. Youth reported that existing support systems, including family and healthcare workers, already provided informational and instrumental support. However, they emphasized unmet companionship and emotional support needs, leading to isolation, hopelessness, and medication adherence challenges. Participants identified connection with other YLWH as a unique source of emotional and companionship support that allowed them to feel more secure and less isolated. Interviews and observed WhatsApp chats demonstrated that WhatsApp groups were a desirable medium for companionship support that overcame barriers to in-person connection.
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Affiliation(s)
- Elise Healy
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | - Cyrus Mugo
- University of Washington, Department of Global Health, Seattle, WA, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - David Seeh
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - Alana R Lopez
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | - Brandon Guthrie
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | | | | | - Keshet Ronen
- University of Washington, Department of Global Health, Seattle, WA, USA
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8
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Omollo V, Roche SD, Mogaka F, Odoyo J, Barnabee G, Bukusi EA, Katz AWK, Morton J, Johnson R, Baeten JM, Celum C, O’Malley G. Provider–client rapport in pre-exposure prophylaxis delivery: a qualitative analysis of provider and client experiences of an implementation science project in Kenya. Sex Reprod Health Matters 2022; 30:2095707. [PMID: 36169648 PMCID: PMC9542727 DOI: 10.1080/26410397.2022.2095707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Daily oral pre-exposure prophylaxis (PrEP) is being incorporated into services frequented by adolescent girls and young women (AGYW) in sub-Saharan Africa who are at a significant risk of HIV. In non-PrEP studies, positive provider–client rapport has been shown to improve patient decision-making and use of medication in clinical care. We examined AGYW and healthcare provider (HCP) perspectives on the value of and strategies for building positive provider–client rapport. We conducted in-depth interviews from January 2018 to December 2019 with 38 AGYW and 15 HCPs from two family planning clinics in Kisumu, Kenya where PrEP was being delivered to AGYW as part of the Prevention Options for Women Evaluation Research (POWER) study. We used semi-structured interview guides and audio-recorded interviews with participant consent. Verbatim transcripts were analysed using thematic content analysis. HCPs and AGYW emphasised the importance of positive provider–client rapport to meet AGYW support needs in PrEP service delivery. HCPs described how they employed rapport-building strategies that strengthened AGYW PrEP uptake and continuation, including: (1) using friendly and non-judgmental tones; (2) maintaining client confidentiality (to build client trust); (3) adopting a conversational approach (to enable accurate risk assessment); (4) actively listening and tailoring counselling (to promote client knowledge, skills, and self-efficacy); and (5) supporting client agency. Positive provider–client relationships and negative experiences identified in this analysis have the potential to facilitate/deter AGYW from using PrEP while at risk. The strategies to enhance provider–client rapport identified in this study could be integrated into PrEP provider training and delivery practices.
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Affiliation(s)
- Victor Omollo
- Clinical Research Scientist, Kenya Medical Research Institute, P. O. Box 614-40100, Agoi Street, Kisumu, Kenya
| | - Stephanie D. Roche
- Staff Scientist, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Felix Mogaka
- Clinical Research Scientist, Kenya Medical Research Institute, Kisumu, Kenya
| | - Josephine Odoyo
- Research and Evaluation Advisor, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Gena Barnabee
- Research and Evaluation Advisor, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Elizabeth A. Bukusi
- Senior Principal Clinical Research Scientist, Kenya Medical Research Institute, Kisumu, Kenya; Research Professor, Department of Global Health; Research Professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Ariana W. K. Katz
- Public Health Analyst, Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA, USA
| | - Jennifer Morton
- Operations Team Manager, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rachel Johnson
- Managing Director, International Clinical Research Center (ICRC), University of Washington, Seattle, WA, USA
| | - Jared M. Baeten
- Professor, Department of Global Health, [Professor] Department of Medicine; Professor, Department of Epidemiology, University of Washington, Seattle, WA, USA; Vice President of Clinical Development, Gilead Sciences, Foster City, CA, USA>
| | - Connie Celum
- Professor, Department of Global Health; Professor, Department of Medicine; [Professor] Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Gabrielle O’Malley
- Professor, Department of Global Health, University of Washington Seattle, Seattle, WA, USA
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Barnabee G, O’Bryan G, Ndeikemona L, Billah I, Silas L, Morgan KL, Shulock K, Mawire S, MacLachlan E, Nghipangelwa J, Muremi E, Ensminger A, Forster N, O’Malley G. Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia. Front Reprod Health 2022; 4:1048702. [PMID: 36545490 PMCID: PMC9760915 DOI: 10.3389/frph.2022.1048702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Despite the potential for community-based approaches to increase access to pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW), there is limited evidence of whether and how they improve PrEP persistence. We compared PrEP persistence among AGYW receiving services through community and hybrid models in Namibia to facility-based services. We subsequently identify potential mechanisms to explain how and why community and hybrid models achieved (or not) improved persistence to inform further service delivery innovation. Methods Data were collected from PrEP service delivery to AGYW over two-years in Namibia's Khomas Region. We used Kaplan-Meier analysis to estimate survival curves for PrEP persistence beyond three-months after initiation and report the cumulative probability of persistence at one- and three-months. Persistence was defined as any PrEP use within three months after initiation followed by a PrEP refill or previously prescribed supply of at least 30 days at the three-month visit. Interviews were conducted with 28 AGYW and 19 providers and analyzed using a deductive-inductive thematic approach. Results From October 2017 through September 2019, 372 (18.7%) AGYW received services through a facility model, 302 (15.1%) through a community model, and 1,320 (66.2%) through a hybrid model. PrEP persistence at one- and three-months was 41.2% and 34.9% in the community model and 6.2% and 4.8% in the hybrid model compared to 36.8% and 26.7% in the facility model. Within the community and hybrid models, we identified three potential mechanisms related to PrEP persistence. Individualized service delivery offered convenience and simplicity which enabled AGYW to overcome barriers to obtaining refills but did not work as well for highly mobile AGYW. Consistent interactions and shared experiences fostered social connectedness with providers and with peers, building social networks and support systems for PrEP use. PrEP and HIV-related stigma, however, was widely experienced outside of these networks. Community-to-facility referral for PrEP refill triggered apprehension towards unfamiliar PrEP services and providers in AGYW, which discouraged persistence. Conclusion Service delivery approaches that offer convenience and simplicity and foster social connectedness may reduce access barriers and increase social support enabling AGYW to self-manage their PrEP use and achieve improved PrEP persistence.
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Affiliation(s)
- Gena Barnabee
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | - Gillian O’Bryan
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lylie Ndeikemona
- Directorate of Special Programmes, Ministry of Health and Social Services, Windhoek, Namibia
| | - Idel Billah
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Lukas Silas
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Karie L. Morgan
- Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI, United States
| | - Katherine Shulock
- Disease Control and Health Statistics (DCHS), Washington State Department of Health, Seattle, WA, United States
| | | | - Ellen MacLachlan
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | - Josua Nghipangelwa
- Oshikoto Regional Directorate, Ministry of Health and Social Services, Omuthiya, Namibia
| | - Elizabeth Muremi
- Khomas Regional Directorate, Ministry of Health and Social Services, Windhoek, Namibia
| | - Alison Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
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Velloza J, Davies LD, Ensminger AL, Theofelus FM, Andjamba H, Kamuingona R, Masseti G, Coomer R, Forster N, O’Malley G. Cycles of Violence Among Young Women in Namibia: Exploring the Links Between Childhood Violence and Adult Intimate Partner Violence From the Violence Against Children and Youth Survey. J Interpers Violence 2022; 37:NP22992-NP23014. [PMID: 35156448 PMCID: PMC9661872 DOI: 10.1177/08862605211073107] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Violence against children is a global public health crisis and is associated with poor mental and physical health outcomes. Childhood violence may also increase the risk of subsequent violence revictimization by an intimate partner. We aimed to understand cycles of violence among adolescent girls and young women in Namibia to inform violence prevention and treatment interventions. Methods: The 2019 Namibia Violence Against Children and Youth Survey (VACS) examined the prevalence of childhood violence and intimate partner violence among 18-24 year old adolescent girls and young women (N = 2434). Using the data, we assessed the prevalence of childhood violence, defined as any physical, sexual, or emotional violence victimization prior to age 18, and estimated the prevalence of intimate partner violence (IPV) after age 18. We used a weighted logistic regression to assess whether childhood violence exposure was associated with subsequent experience of IPV after age 18. Results: Adolescent girls and young women in Namibia had a statistically significant higher odds of experiencing IPV if they had experienced any childhood violence including physical, sexual, and/or emotional violence (adjusted odds ratio [aOR]: 2.93; 95% Confidence Interval [95% CI: 1.64-5.23). IPV was also significantly associated with childhood physical (aOR: 1.81; 95% CI: 1.07-3.05), sexual (aOR: 3.79; 95% CI: 2.54-5.67), or emotional (aOR: 2.39; 95% CI: 1.18-4.86) violence when each were considered separately. We also observed a dose-response relationship between the number of types of childhood violence and IPV experience as a young adult. Conclusions: Childhood violence is a significant predictor of subsequent violence revictimization by an intimate partner. This analysis provides unique insights on cycles of violence among adolescent girls and young women in Namibia and points to the need for interventions during childhood to prevent violence against children and break this cycle among young women in sub-Saharan Africa.
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Affiliation(s)
- Jennifer Velloza
- University of Washington, Department of Global Health, Seattle, WA, USA
| | - Luke D. Davies
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | - Alison L. Ensminger
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | | | - Helena Andjamba
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Rahimisa Kamuingona
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Greta Masseti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Norbert Forster
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
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Wiggins L, O’Malley G, Wagner AD, Mutisya I, Wilson KS, Lawrence S, Moraa H, Kinuthia J, Itindi J, Muhenje O, Chen TH, Singa B, Mcgrath CJ, Ngugi E, Katana A, Ng′ang′a L, John-Stewart G, Kholer P, Beima-Sofie K. 'They can stigmatize you': a qualitative assessment of the influence of school factors on engagement in care and medication adherence among adolescents with HIV in Western Kenya. Health Educ Res 2022; 37:355-363. [PMID: 36053049 PMCID: PMC9502837 DOI: 10.1093/her/cyac018] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
School-related factors may influence retention in care and adherence to antiretroviral therapy (ART) among adolescents with human immunodeficiency virus (HIV). We analyzed data from in-depth interviews with 40 adolescents with HIV (aged 14 -19 years), 40 caregivers of adolescents with HIV, and 4 focus group discussions with healthcare workers to evaluate contextual factors affecting adherence to ART and clinic attendance among adolescents, with a focus on the school environment. Informed by Anderson's Model of Health Services Utilization, transcripts were systematically coded and synthesized to identify school-related themes. All groups identified the school environment as a critical barrier to engagement in HIV care and medication adherence for adolescents with HIV. Adolescent participants reported inflexible school schedules and disclosure to school staff as the biggest challenges adhering to clinic appointments and ART. Adolescents described experiencing stigma and discrimination by peers and school staff and would adjust when, where and how often they took ART to avoid inadvertent disclosure. Boarding school students faced challenges because they had limited private space or time. Caregivers were often instrumental in navigating school permissions, including identifying a treatment supporter among school staff. Additional research engaging school staff may guide interventions for schools to reduce stigma and improve adherence and retention.
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Affiliation(s)
- Lisa Wiggins
- Department of Child Family and Population Health Nursing
| | - Gabrielle O’Malley
- Department of Global Health, University of Washington, Seattle, Washington
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, Washington
| | - Immaculate Mutisya
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Kate S Wilson
- Department of Global Health, University of Washington, Seattle, Washington
| | - Sarah Lawrence
- Department of Global Health, University of Washington, Seattle, Washington
| | - Hellen Moraa
- Department of Pediatrics, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Janet Itindi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Odylia Muhenje
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Tai-Ho Chen
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Benson Singa
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Evelyn Ngugi
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Lucy Ng′ang′a
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Pamela Kholer
- Department of Child Family and Population Health Nursing
- Department of Global Health, University of Washington, Seattle, Washington
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12
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Neary J, Bulterys MA, Ogutu EA, O’Malley G, Otieno AA, Omondi VO, Wang Y, Zhai X, Katz DA, Oyiengo L, Wamalwa DC, Slyker JA, John-Stewart GC, Njuguna IN, Wagner AD. Brief Report: Pediatric Saliva-Based HIV Testing: Health care Worker and Caregiver Acceptability. J Acquir Immune Defic Syndr 2022; 90:517-523. [PMID: 35499505 PMCID: PMC9283261 DOI: 10.1097/qai.0000000000003004] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric HIV testing remains suboptimal. The OraQuick test [saliva-based test (SBT)] is validated in pediatric populations ≥18 months. Understanding caregiver and health care worker (HCW) acceptability of pediatric SBT is critical for implementation. METHODS A trained qualitative interviewer conducted 8 focus group discussions (FGDs): 4 with HCWs and 4 with caregivers of children seeking health services in western Kenya. FGDs explored acceptability of pediatric SBT and home- and facility-based SBT use. Two reviewers conducted consensus coding and thematic analyses of transcripts using Dedoose. RESULTS Most HCWs but few caregivers had heard of SBT. Before seeing SBT instructions, both had concerns about potential HIV transmission through saliva, which were mostly alleviated after kit demonstration. Noted benefits of SBT included usability and avoiding finger pricks. Benefits of facility-based pediatric SBT included shorter client waiting and service time, higher testing coverage, and access to HCWs, while noted challenges included ensuring confidentiality. Benefits of caregivers using home-based SBT included convenience, privacy, decreased travel costs, increased testing, easier administration, and child comfort. Perceived challenges included not receiving counseling, disagreements with partners, child neglect, and negative emotional response to a positive test result. Overall, HCWs felt that SBT could be used for pediatric HIV testing but saw limited utility for caregivers performing SBT without an HCW present. Caregivers saw utility in home-based SBT but wanted easy access to counseling in case of a positive test result. CONCLUSIONS SBT was generally acceptable to HCWs and caregivers and is a promising strategy to expand testing coverage.
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Affiliation(s)
- Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Emily A. Ogutu
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - Gabrielle O’Malley
- Department of Global Health, University of Washington, Seattle, WA
- International Training and Education Center for Health, University of Washington, Seattle, WA
| | | | | | - Yu Wang
- Department of Global Health, University of Washington, Seattle, WA
| | - Xinyi Zhai
- Department of Global Health, University of Washington, Seattle, WA
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA
| | - Laura Oyiengo
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Dalton C. Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jennifer A. Slyker
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | - Grace C. John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Irene N. Njuguna
- Department of Global Health, University of Washington, Seattle, WA
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA
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13
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Roche SD, Barnabee G, Omollo V, Mogaka F, Odoyo J, Bukusi EA, Morton JF, Johnson R, Celum C, Baeten JM, O’Malley G. Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study. BMC Health Serv Res 2022; 22:422. [PMID: 35354456 PMCID: PMC8969252 DOI: 10.1186/s12913-022-07742-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Across sub-Saharan Africa, ministries of health have proposed integrating pre-exposure prophylaxis (PrEP) for HIV prevention into family planning (FP) services to reach adolescent girls and young women (AGYW); however, evidence on effective implementation strategies is still limited. We conducted a qualitative study of integrated PrEP-FP service implementation at two FP clinics in Kisumu, Kenya. METHODS From June 2017 to May 2020, the Prevention Options for Women Evaluation Research (POWER) study enrolled 1000 sexually active, HIV-negative AGYW age 16 to 25. Actions taken to implement PrEP were captured prospectively in 214 monitoring and evaluation documents and 15 interviews with PrEP implementers. We analysed data using conventional and directed content analysis, with the latter informed by the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) compilation. RESULTS POWER deployed a variety of implementation strategies to train and educate stakeholders (e.g., having new providers shadow PrEP providers); develop stakeholder interrelationships (e.g., organizing support teams with protected time to reflect on implementation progress and make refinements); provide technical assistance; and change physical infrastructure and workflow. Although these strategies reportedly influenced contextual factors across four of the five CFIR domains, they primarily interacted with contextual factors relevant to inner setting, especially implementation climate and readiness for implementation. Overall, implementing PrEP proved easier and less labor-intensive at a private, youth-friendly clinic than a public FP clinic, largely because the baseline structural characteristics (e.g., space, workflow) and organizational mission of the former were more conducive to offering AGYW-centered care. Nevertheless, adoption of PrEP delivery among non-study staff at both sites was low, likely due to the widespread perception that PrEP was not within their scope of work. CONCLUSIONS Some FP clinics may be "lower-hanging fruit" than others for PrEP implementation. Approaching PrEP implementation as a behavioral intervention for FP providers may help ensure that providers have the requisite capability, opportunity, and motivation to adopt the clinical innovation. In particular, PrEP implementers should assess the need for implementation strategies that support providers' clinical decision-making, establish worker expectations and accountability, and address workload constraints. TRIAL REGISTRATION Clinical Trial Number: NCT03490058 .
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Affiliation(s)
- Stephanie D. Roche
- Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA 98104 USA
| | - Gena Barnabee
- Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA 98104 USA
| | - Victor Omollo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Felix Mogaka
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Josephine Odoyo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A. Bukusi
- Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA 98104 USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - Jennifer F. Morton
- Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA 98104 USA
| | - Rachel Johnson
- Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA 98104 USA
| | - Connie Celum
- Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA 98104 USA
- Department of Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Jared M. Baeten
- Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA 98104 USA
- Department of Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
- Gilead Sciences, Foster City, USA
| | - Gabrielle O’Malley
- Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA 98104 USA
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14
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Telford CT, Tessema Z, Msukwa M, Arons MM, Theu J, Bangara FF, Ernst A, Welty S, O’Malley G, Dobbs T, Shanmugam V, Kabaghe A, Dale H, Wadonda-Kabondo N, Gugsa S, Kim A, Bello G, Eaton JW, Jahn A, Nyirenda R, Parekh BS, Shiraishi RW, Kim E, Tobias JL, Curran KG, Payne D, Auld AF. Geospatial Transmission Hotspots of Recent HIV Infection - Malawi, October 2019-March 2020. MMWR Morb Mortal Wkly Rep 2022; 71:329-334. [PMID: 35239633 PMCID: PMC8893337 DOI: 10.15585/mmwr.mm7109a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Persons infected with HIV are more likely to transmit the virus during the early stages (acute and recent) of infection, when viral load is elevated and opportunities to implement risk reduction are limited because persons are typically unaware of their status (1,2). Identifying recent HIV infections (acquired within the preceding 12 months)* is critical to understanding the factors and geographic areas associated with transmission to strengthen program intervention, including treatment and prevention (2). During June 2019, a novel recent infection surveillance initiative was integrated into routine HIV testing services in Malawi, a landlocked country in southeastern Africa with one of the world's highest prevalences of HIV infection.† The objectives of this initiative were to collect data on new HIV diagnoses, characterize the epidemic, and guide public health response (2). New HIV diagnoses were classified as recent infections based on a testing algorithm that included results from the rapid test for recent infection (RTRI)§ and HIV viral load testing (3,4). Among 9,168 persons aged ≥15 years with a new HIV diagnosis who received testing across 103 facilities during October 2019-March 2020, a total of 304 (3.3%) were classified as having a recent infection. Higher proportions of recent infections were detected among females, persons aged <30 years, and clients at maternal and child health and youth clinics. Using a software application that analyzes clustering in spatially referenced data, transmission hotspots were identified with rates of recent infection that were significantly higher than expected. These near real-time HIV surveillance data highlighted locations across Malawi, allowing HIV program stakeholders to assess program gaps and improve access to HIV testing, prevention, and treatment services. Hotspot investigation information could be used to tailor HIV testing, prevention, and treatment to ultimately interrupt transmission.
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15
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Rogers Z, Pintye J, Kinuthia J, O’Malley G, Abuna F, Escudero J, Mugambi M, Awuor M, Dollah A, Dettinger JC, Kohler P, John-Stewart G, Beima-Sofie K. Key influences on the decision to initiate PrEP among adolescent girls and young women within routine maternal child health and family planning clinics in Western Kenya. AIDS Care 2022; 34:363-370. [PMID: 34543077 PMCID: PMC8934309 DOI: 10.1080/09540121.2021.1981217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We sought to understand influences on PrEP uptake among Kenyan adolescent girls and young women (AGYW) whose decision on PrEP use was misaligned with their risk for HIV acquisition. In-depth interviews were conducted with 47 Kenyan HIV-negative AGYW aged 15-24 years who were offered PrEP during routine maternal and child health and family planning services. AGYW were sampled from two groups (1) declined PrEP and had ≥1 sexual partner(s) of unknown HIV status and (2) initiated PrEP and reported having one HIV-negative partner. AGYW with HIV-negative partners initiated PrEP due to known or suspected infidelity. AGYW with partners of unknown HIV status recognized PrEP as a helpful HIV prevention tool, yet worried about partner reactions and prioritized avoiding uncomfortable or unsafe situations over PrEP. Among pregnant AGYW, the responsibility of motherhood and providing a future for one's family, through staying healthy and remaining HIV-free, was a strong PrEP use motivator. Among AGYW who desired future motherhood, fears that PrEP could negatively impact fertility or reduce contraceptive effectiveness led to declining PrEP. Peers positively influenced PrEP decision-making, especially personally knowing a PrEP user. Strategies are needed to enhance messaging and delivery approaches that are tailored to AGYW, including peer-led strategies.
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Affiliation(s)
- Zoe Rogers
- University of Washington Department of Global Health, Seattle, WA, USA
| | - Jillian Pintye
- University of Washington, Department of Biobehavioral Nursing and Health Informatics, Seattle, WA, USA
| | - John Kinuthia
- University of Washington Department of Global Health, Seattle, WA, USA,Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Jaclyn Escudero
- University of Washington Department of Global Health, Seattle, WA, USA
| | - Melissa Mugambi
- University of Washington Department of Global Health, Seattle, WA, USA
| | | | | | - Julia C Dettinger
- University of Washington Department of Global Health, Seattle, WA, USA
| | - Pamela Kohler
- University of Washington Department of Global Health, Seattle, WA, USA,University of Washington Child, Family, and Population Health, Seattle, WA, USA
| | - Grace John-Stewart
- University of Washington Department of Global Health, Seattle, WA, USA,University of Washington, Department of Epidemiology, Seattle, WA, USA,University of Washington, Department of Medicine, Seattle, WA, USA,University of Washington, Department of Pediatrics, Seattle, WA, USA
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O’Bryan G, Feldacker C, Ensminger A, Nghatanga M, Brandt L, Shepard M, Billah I, Aupokolo M, Mengistu AT, Forster N, Zemburuka B, Sithole E, Mutandi G, Barnhart S, O’Malley G. Adverse event profile and associated factors following surgical voluntary medical male circumcision in two regions of Namibia, 2015-2018. PLoS One 2021; 16:e0258611. [PMID: 34669709 PMCID: PMC8528325 DOI: 10.1371/journal.pone.0258611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/23/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Monitoring clinical safety of voluntary medical male circumcision (VMMC) is critical to minimize risk as VMMC programs for HIV prevention are scaled. This cross-sectional analysis describes the adverse event (AE) profile of a large-scale, routine VMMC program and identifies factors associated with the development, severity, and timing of AEs to provide recommendations for program quality improvement. Materials and methods From 2015–2018 there were 28,990 circumcisions performed in International Training and Education Center for Health (I-TECH) supported regions of Namibia in collaboration with the Ministry of Health and Social Services. Two routine follow-up visits after VMMC were scheduled to identify clients with AEs. Summary statistics were used to describe characteristics of all VMMC clients and the subset who experienced an AE. We used chi-square tests to evaluate associations between AE timing, patient age, and other patient and AE characteristics. We used a logistic regression model to explore associations between patient characteristics and AE severity. Results Of the 498 clients with AEs (AE rate of 1.7%), 40 (8%) occurred ≤2 days, 262 (53%) occurred 3–7 days, 161 (32%) between day 8 and 14, and 35 (7%) were ≥15 days post-VMMC. Early AEs (on or before day 2) tended to be severe and categorized as bleeding, while infections were the most common AEs occurring later (p<0.001). Younger clients (aged 10–14 years) experienced more infections, whereas older clients experienced more bleeding (p<0.001). Conclusions Almost 40% of AEs occurred after the second follow-up visit, of which 179 (91%) were infections. Improvements in pre-surgical and post-surgical counselling and post-operative educational materials encouraging clients to seek care at any time, adoption of alternative follow-up methods, and the addition of a third follow-up visit may improve outcomes for patients. Enhancing post-surgical counselling and emphasizing wound care for younger VMMC clients and their caregivers could help mitigate elevated risk of infection.
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Affiliation(s)
- Gillian O’Bryan
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | - Caryl Feldacker
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Alison Ensminger
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Magdaleena Nghatanga
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Laura Brandt
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Mark Shepard
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Idel Billah
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Mekondjo Aupokolo
- Directorate of Special Programs-Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Norbert Forster
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Brigitte Zemburuka
- Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia
| | - Edwin Sithole
- Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia
| | - Gram Mutandi
- Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia
| | - Scott Barnhart
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Gabrielle O’Malley
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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Rousseau E, Katz AWK, O’Rourke S, Bekker LG, Delany-Moretlwe S, Bukusi E, Travill D, Omollo V, Morton JF, O’Malley G, Haberer JE, Heffron R, Johnson R, Celum C, Baeten JM, van der Straten A. Adolescent girls and young women's PrEP-user journey during an implementation science study in South Africa and Kenya. PLoS One 2021; 16:e0258542. [PMID: 34648589 PMCID: PMC8516266 DOI: 10.1371/journal.pone.0258542] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [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: 04/28/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
Successful scale-up of PrEP for HIV prevention in African adolescent girls and young women (AGYW) requires integration of PrEP into young women's everyday lives. We conducted interviews and focus group discussions with 137 AGYW PrEP users aged 16-25 from South Africa and Kenya. Individual and relational enablers and disablers were explored at key moments during their PrEP-user journey from awareness, initiation and early use through persistence, including PrEP pauses, restarts, and discontinuation. PrEP uptake was facilitated when offered as part of an integrated sexual reproductive health service, but hampered by low awareness, stigma and misconceptions about PrEP in the community. Daily pill-taking was challenging for AGYW due to individual, relational and structural factors and PrEP interruptions (intended or unintended) were described as part of AGYW's PrEP-user journey. Disclosure, social support, adolescent-friendly health counseling, and convenient access to PrEP were reported as key enablers for PrEP persistence.
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Affiliation(s)
- Elzette Rousseau
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Ariana W. K. Katz
- RTI International, Women’s Global Health Imperative (WGHI), Berkeley, CA, United States of America
| | - Shannon O’Rourke
- RTI International, Women’s Global Health Imperative (WGHI), Berkeley, CA, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | | | - Danielle Travill
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jennifer F. Morton
- International Clinical Research Center, University of Washington, Seattle, WA, United States of America
| | - Gabrielle O’Malley
- International Clinical Research Center, University of Washington, Seattle, WA, United States of America
| | - Jessica E. Haberer
- Harvard Medical School, Harvard University, Boston, MA, United States of America
- Centre for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
| | - Renee Heffron
- International Clinical Research Center, University of Washington, Seattle, WA, United States of America
| | - Rachel Johnson
- International Clinical Research Center, University of Washington, Seattle, WA, United States of America
| | - Connie Celum
- International Clinical Research Center, University of Washington, Seattle, WA, United States of America
| | - Jared M. Baeten
- International Clinical Research Center, University of Washington, Seattle, WA, United States of America
- Gilead Sciences, Inc., Seattle, WA, United States of America
| | - Ariane van der Straten
- Centre for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, United States of America
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Gachuno O, Odero T, Seloilwe E, Urassa D, Tarimo E, Nakanjako D, Sewankambo N, S Atanga N, G Halle-Ekane E, Manabe Y, N Hosey K, A Chapman S, J Wiebe D, Voss J, O’Malley G, Mashalla Y, Ndegwa M, Omogi J, Farquhar C, N Wasserheit J. AFYA BORA CONSORTIUM FELLOWSHIP: a journey of success in Global Health Leadership Training. Afr Health Sci 2021. [DOI: 10.4314/ahs.v21i.1s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ongolly FK, Dolla A, Ngure K, Irungu EM, Odoyo J, Wamoni E, Peebles K, Mugwanya K, Mugo NR, Bukusi EA, Morton J, Baeten JM, O’Malley G. "I Just Decided to Stop:" Understanding PrEP Discontinuation Among Individuals Initiating PrEP in HIV Care Centers in Kenya. J Acquir Immune Defic Syndr 2021; 87:e150-e158. [PMID: 33492024 PMCID: PMC8026512 DOI: 10.1097/qai.0000000000002625] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) discontinuation rates in clinical trials and demonstration projects have been well characterized; however, little is known about discontinuation in routine public health settings in sub-Saharan Africa. Understanding discontinuation in nonstudy settings is important for establishing expectations for PrEP continuation in national programs and for facilitating effective PrEP scale-up. METHODS We conducted in-depth interviews with 46 individuals who had initiated PrEP at 25 HIV comprehensive care clinics (CCCs) in central and western Kenya and whose clinic records indicated they had discontinued. RESULTS Many of our study participants discontinued PrEP when their perceived risk decreased (eg, hiatus or end of a sexual relationship or partner known to be living with HIV became virally suppressed). Others reported discontinuation due to side effects, daily pill burden, preference for condoms, or their partner's insistence. Participant narratives frequently described facility level factors such as stigma-related discomforts with accessing PrEP at CCCs, inconvenient clinic location or operating hours, long wait times, and short refill dates as discouraging factors, suggesting actionable areas for improving PrEP access and continuation. CONCLUSION Clients frequently make intentional decisions to discontinue PrEP as they weigh different prevention options within the context of complex lives. Many clients will decide to discontinue PrEP when perceiving themselves to be at reduced risk and PrEP counseling must include provisions for addressing seasons of risk. PrEP will not be the right prevention method for everyone, or forever. Expanding PrEP access points and increasing sex-positive messaging may facilitate PrEP being a better option for many.
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Affiliation(s)
| | - Annabel Dolla
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, Seattle, Washington, USA
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Elizabeth M. Irungu
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Elizabeth Wamoni
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Kathryn Peebles
- Department of Epidemiology, Medicine, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Kenneth Mugwanya
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Nelly R. Mugo
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
- Department of Global Health, Seattle, Washington, USA
| | - Elizabeth A. Bukusi
- Department of Global Health, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, Seattle, Washington, USA
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Jennifer Morton
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Jared M. Baeten
- Department of Global Health, Seattle, Washington, USA
- Department of Epidemiology, Medicine, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Gabrielle O’Malley
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
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20
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Pintye J, O’Malley G, Kinuthia J, Abuna F, Escudero JN, Mugambi M, Awuor M, Dollah A, Dettinger JC, Kohler P, John-Stewart G, Beima-Sofie K. Influences on Early Discontinuation and Persistence of Daily Oral PrEP Use Among Kenyan Adolescent Girls and Young Women: A Qualitative Evaluation From a PrEP Implementation Program. J Acquir Immune Defic Syndr 2021; 86:e83-e89. [PMID: 33273211 PMCID: PMC8935942 DOI: 10.1097/qai.0000000000002587] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/20/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Discontinuation of daily oral pre-exposure prophylaxis (PrEP) is frequent among adolescent girls and young women (AGYW) in African settings. We explored factors influencing early PrEP discontinuation and persistence among Kenyan AGYW who accepted PrEP within a programmatic setting. METHODS We conducted in-depth interviews with AGYW (aged 15-24 years) who accepted PrEP from 4 maternal child health (MCH) and family planning (FP) clinics. AGYW were identified by nurses at routine clinic visits and purposively sampled based on 4 categories: (1) accepted PrEP pills, but never initiated PrEP use (eg, never swallowed PrEP pills), (2) discontinued PrEP <1 month after initiation, (3) discontinued PrEP within 1-3 months, and (4) persisted with PrEP use >3 months. Informed by the Stages of Change Model, thematic analysis characterized key influences on PrEP discontinuation/persistence. RESULTS We conducted 93 in-depth interviews with AGYW who accepted pills. Median age was 22 years, 71% were married; 89% were from MCH, and 11% were from FP clinics. Early PrEP use was positively influenced by encouragement from close confidants and effective concealment of PrEP pill-taking when necessary to avoid stigma or negative reactions from partners. Pregnancy helped conceal PrEP use because pill-taking is normalized during pregnancy, but concealment became more difficult postpartum. AGYW found keeping up with daily PrEP pill-taking challenging, and many noted only episodic periods of the HIV risk. Frequently testing HIV-negative reassured AGYW that PrEP was working and motivated persistence. DISCUSSION As PrEP programs scale-up in MCH/FP, it is increasingly important to enhance protection-effective PrEP use through approaches tailored to AGYW, with special considerations during pregnancy and postpartum.
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Affiliation(s)
- Jillian Pintye
- University of Washington, Department of Biobehavioral Nursing and Health Informatics, Seattle, WA, USA
| | | | - John Kinuthia
- University of Washington, Department of Global Health, Seattle, WA, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Melissa Mugambi
- University of Washington, Department of Global Health, Seattle, WA, USA
| | - Mercy Awuor
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Julia C Dettinger
- University of Washington, Department of Global Health, Seattle, WA, USA
| | - Pamela Kohler
- University of Washington, Department of Global Health, Seattle, WA, USA
- University of Washington Child, Family, and Population Health, Seattle, WA, USA
| | - Grace John-Stewart
- University of Washington, Department of Global Health, Seattle, WA, USA
- University of Washington, Department of Epidemiology, Seattle, WA, USA
- University of Washington, Department of Medicine, Seattle, WA, USA
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21
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Dow M, Brinkley A, O’Malley G, Murrin C. Psychosocial difficulties, obesity and disadvantage in a cohort of Irish children. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Childhood obesity is stabilising in Ireland, but less so in children from disadvantaged backgrounds. There is also evidence for a relationship between psychosocial difficulties and obesity in youth, but findings are often mixed. This study aimed to describe the relationships between psychosocial difficulties, obesity, and disadvantage in a national cohort of children in Ireland.
Methods
Participants (n = 7275) were surveyed and measured at age nine and thirteen as part of the Growing Up in Ireland study (GUI). Psychosocial difficulties were measured using the Strengths and Difficulties Questionnaire (SDQ). Disadvantage was represented by the education status of the primary caregiver. BMI was calculated using measured height and weight. Weight status categories were created using the UK 1990 Growth Data. Correlation analyses were used to examine the relationship between child BMI and SDQ scores. Associations between weight categories, psychosocial difficulties and education status were examined using Chi-square analysis.
Results
In children whose parents had secondary education, the obesity rate was 27.9%, compared to 24.7% in those with a college degree (p < 0.01). This relationship was also significant at age thirteen (<0.01). Furthermore, BMI was positively correlated with SDQ total score, (r=.107, p = 0.01) at age nine and at age thirteen (r=.089, p = 0.01). A significant association was also found between weight status categories and psychosocial difficulties at ages nine (p < 0.1), and thirteen (p < 0.1). Further findings will be reported following a preliminary longitudinal analysis.
Conclusions
Obesity is associated with psychosocial difficulties, as well as the education status of the primary caregiver, in a large sample of Irish children. These findings are important for understanding the relationship between childhood obesity and psychological health and have implications for the treatment of obesity in young people.
Key messages
There are higher rates of obesity in children whose parents do not have a college degree. Childhood obesity remains a serious public health issue, and is associated with psychosocial difficulties in an Irish cohort of children.
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Affiliation(s)
- M Dow
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- W82GO Programme, Temple Street Children’s University Hospital, Dublin, Ireland
| | - A Brinkley
- W82GO Programme, Temple Street Children’s University Hospital, Dublin, Ireland
| | - G O’Malley
- W82GO Programme, Temple Street Children’s University Hospital, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Tefera F, Barnabee G, Sharma A, Feleke B, Atnafu D, Haymanot N, O’Malley G, Feleke G. Evaluation of facility and community-based active household tuberculosis contact investigation in Ethiopia: a cross-sectional study. BMC Health Serv Res 2019; 19:234. [PMID: 31010427 PMCID: PMC6477729 DOI: 10.1186/s12913-019-4074-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/09/2018] [Accepted: 04/08/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND No established strategy for household tuberculosis (TB) contact investigation (HTCI) exists in Ethiopia. We implemented integrated, active HTCI model into two hospitals and surrounding community health services to determine yield of active HTCI of all forms of TB and explore factors associated with active TB diagnosis in household contacts (HHCs). METHODS Case managers obtained HHC information from index cases at TB/DOTS clinic and liaised with health extension workers (HEWs) who screened HHCs for TB at household and referred contacts under five and presumptive cases for diagnostic investigation. RESULTS From 363 all forms TB index cases, 1509 (99%) HHCs were screened and 809 (54%) referred, yielding 19 (1.3%) all forms TB cases. HTCI of sputum smear-positive pulmonary TB (SS + PTB) index cases produced yield of 4.3%. HHCs with active TB were more likely to be malnourished (OR: 3.39, 95%CI: 1.19-9.64), live in households with SS + PTB index case (OR: 7.43, 95%CI: 1.64-33.73) or TB history (OR: 4.18, 95%CI: 1.51-11.55). CONCLUSION Active HTCI of all forms of TB cases produced comparable or higher yield than reported elsewhere. HTCI contributes to improved and timely case detection of Tuberculosis among population who may not seek health care due to minimal symptoms or access issues. Active HTCI can successfully be implemented through integrated approach with existing community TB programs for better coordination and efficiency. Referral criteria should include factors significantly associated with active disease.
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Affiliation(s)
- Fana Tefera
- Centers for Disease Control and Prevention- Ethiopia (CDC-Ethiopia), US Embassy, Entoto Road, P.O. Box 19284, Addis Ababa, Ethiopia
| | - Gena Barnabee
- University of Washington, International Training and Education Center for Health (I-TECH), Seattle, WA USA
| | - Anjali Sharma
- University of Washington, International Training and Education Center for Health (I-TECH), Seattle, WA USA
| | - Beniam Feleke
- Centers for Disease Control and Prevention- Ethiopia (CDC-Ethiopia), US Embassy, Entoto Road, P.O. Box 19284, Addis Ababa, Ethiopia
| | - Daniel Atnafu
- International Training and Education Center for Health (I-TECH Ethiopia), Addis Ababa, Ethiopia
| | | | - Gabrielle O’Malley
- University of Washington, International Training and Education Center for Health (I-TECH), Seattle, WA USA
| | - Getachew Feleke
- International Training and Education Center for Health (I-TECH Ethiopia), Addis Ababa, Ethiopia
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Narayan V, John-Stewart G, Gage G, O’Malley G. "If I had known, I would have applied": poor communication, job dissatisfaction, and attrition of rural health workers in Sierra Leone. Hum Resour Health 2018; 16:50. [PMID: 30249253 PMCID: PMC6154815 DOI: 10.1186/s12960-018-0311-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/27/2018] [Accepted: 08/26/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Sierra Leone's health outcomes rank among the worst in the world. A major challenge is the shortage of primary healthcare workers (HCWs) in rural areas due to especially high rates of attrition. This study was undertaken to determine the drivers of job dissatisfaction and poor retention among Sierra Leone's rural HCWs. METHODS Interviews were conducted with 58 rural and 32 urban primary HCWs in Sierra Leone's public health sector, complemented by key informant discussions and review of national policy documents. HCW interviews included (1) semi-structured discussion, (2) questionnaire, (3) card sort about HCW priorities, and (4) free-listing of most pressing challenges and needs. Sampling for HCW interviews was stratified purposive, emphasizing rural HCWs. RESULTS Among 90 HCWs interviewed, 67% were dissatisfied with their jobs (71% rural vs 52% urban) and 61% intended to leave their post (75% rural vs 38% urban). While working and living conditions and remuneration were significant factors, a major reason for rural HCW disenchantment was their inability to access worker rights, benefits, and advancement opportunities. This was caused by HCWs' lack of knowledge about human resource (HR) policies and procedures, as well as ambiguity in many policies and inequitable implementation. HCWs reported feeling neglected and marginalized and perceived a lack of transparency. These issues can be attributed to the absence of systems for regular two-way communication between the Ministry of Health and HCWs; lack of official national documents with up-to-date, clear HR policies and procedures for HCWs; pay statements that do not provide a breakdown of financial allowances and withholdings; and lack of HCW induction. CONCLUSIONS HCWs in Sierra Leone lacked accurate information about entitlements, policies, and procedures, and this was a driver of rural HCW job dissatisfaction and attrition. System-oriented, low-cost initiatives can address these underlying structural causes in Sierra Leone. These issues likely apply to other countries facing HCW retention challenges and should be considered in development of global HCW retention strategies.
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Affiliation(s)
- Vijay Narayan
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, United States of America
| | - George Gage
- College of Medicine and Applied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gabrielle O’Malley
- Department of Global Health, University of Washington, Seattle, United States of America
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Asiimwe S, Ross JM, Arinaitwe A, Tumusiime O, Turyamureeba B, Roberts DA, O’Malley G, Barnabas RV. Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers. J Int AIDS Soc 2017; 20:21633. [PMID: 28770598 PMCID: PMC5577731 DOI: 10.7448/ias.20.5.21633] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 11/03/2016] [Accepted: 04/25/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Achieving the UNAIDS goals of 90-90-90 will require more than doubling the number of people accessing HIV care in Uganda. Community-based programmes for entry into HIV care are effective strategies to expand access to HIV care, but few programmes have been evaluated with a particular focus on scale-up. METHODS Integrated Community Based Initiatives, a Uganda-based non-governmental organization, designed and implemented a programme of community-based HIV counselling and testing and facilitated linkage to care utilizing community health extension workers (CHEWs) in rural Sheema District, Uganda. CHEWs performed programme activities during 1 October 2015 through 31 March 2016. Outcomes for this evaluation were (1) the number of people tested for HIV, and (2) the proportion of those testing positive who were seen at an ART clinic within three months of their positive test, and (3) the cost of the programme per person newly diagnosed with HIV. Microcosting methods were used to calculate the programme costs. Program scalability factors were evaluated using a published framework. RESULTS Sixty-two CHEWs attended a five-day training that introduced the biology of HIV, the conduct of confidential HIV testing, HIV prevention messages, and linkage, referral, and reporting requirements. CHEWs received a $30 monthly stipend and a field testing kit that included a bicycle, field bag, umbrella, gumboots, reporting booklet, pens, and HIV testing materials. Trained CHEWs tested 43,696 persons for HIV infection during the six-month programme period. Nine-hundred seventy-four participants (2.2%) were identified as HIV positive, and 623 participants (64%) were linked to HIV care. An estimated 69% of adult residents received testing as part of this campaign. The programme cost $3.02 per person test, $135.70 per positive person identified, and $212.15 per HIV-positive person linked to care. CONCLUSIONS Lay community health extension workers (CHEWs) can be rapidly trained to scale-up home-based HIV testing and counselling (HTC) and linkage to care in a high-quality and low-cost manner to large numbers of people in a rural, high burden setting. A combination HIV testing approach, such as adding partner testing to community-based testing, could increase the proportion of HIV-positive persons identified.
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Affiliation(s)
| | - Jennifer M. Ross
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Ruanne V. Barnabas
- Departments of Global Health, Medicine (Allergy and Infectious Disease), and Epidemiology, University of Washington, Seattle, WA, USA
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Wagner AD, Mugo C, Bluemer-Miroite S, Mutiti PM, Wamalwa DC, Bukusi D, Neary J, Njuguna IN, O’Malley G, John-Stewart GC, Slyker JA, Kohler PK. Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge. AIDS 2017; 31 Suppl 3:S243-S252. [PMID: 28665882 PMCID: PMC5497779 DOI: 10.1097/qad.0000000000001531] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 02/01/2017] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether continuous quality improvement (CQI) improves quality of HIV testing services for adolescents and young adults (AYA). DESIGN CQI was introduced at two HIV testing settings: Youth Centre and Voluntary Counseling and Testing (VCT) Center, at a national referral hospital in Nairobi, Kenya. METHODS Primary outcomes were AYA satisfaction with HIV testing services, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted. RESULTS There were 172 AYA (Youth Centre = 109, VCT = 63) during 6 baseline weeks and 702 (Youth Centre = 454, VCT = 248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at Youth Centre: 18 vs. 63% [adjusted risk difference (aRD) 0.42,95% confidence interval (CI) 0.21 to 0.63], and a trend at VCT: 38 vs. 72% (aRD 0.30, 95% CI -0.04 to 0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46 vs. 61% (aRD 0.39, 95% CI 0.02-0.76), but not Youth Centre (P = 0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs. 4.3; aRD 0.78, 95% CI -0.11 to 1.67), but not at Youth Centre (P = 0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (P = 0.384, P = 0.755). HCW satisfaction remained high during intervention and baseline (P = 0.746). CONCLUSION CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.
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Affiliation(s)
- Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Cyrus Mugo
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Shay Bluemer-Miroite
- International Training and Education Center for Health, University of Washington, Seattle, Washington, USA
| | - Peter M. Mutiti
- VCT and HIV Prevention Unit/Youth Centre, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton C. Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - David Bukusi
- VCT and HIV Prevention Unit/Youth Centre, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Irene N. Njuguna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Gabrielle O’Malley
- Department of Global Health, University of Washington, Seattle, Washington, USA
- International Training and Education Center for Health, University of Washington, Seattle, Washington, USA
| | - Grace C. John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- School of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jennifer A. Slyker
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Pamela K. Kohler
- Department of Global Health, University of Washington, Seattle, Washington, USA
- International Training and Education Center for Health, University of Washington, Seattle, Washington, USA
- Department of Psychosocial and Community Health
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Gugsa S, Potter K, Tweya H, Phiri S, Sande O, Sikwese P, Chikonda J, O’Malley G. Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study. PLoS One 2017. [PMID: 28636669 PMCID: PMC5479573 DOI: 10.1371/journal.pone.0179838] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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] [Indexed: 11/19/2022] Open
Abstract
Although several studies have documented challenges related to inadequate adherence to antiretroviral therapy (ART) and high loss to follow-up (LTFU) among Option B+ women, there is limited understanding of why these challenges occur and how to address them. This qualitative study examines women's experiences with ART adherence and retention in care. Between July and October 2015, in-depth interviews were conducted with 39 pregnant and lactating women who initiated ART at Bwaila Hospital in Lilongwe, Malawi. Study participants included 14 in care and 25 out of care women, according to facility records. Data were analyzed using an inductive, open-coding approach to thematic analysis. Ten of the respondents (7 out of care, 3 in-care) had stopped and re-started treatment before the interview date. One of the most important factors influencing adherence and retention was the strength of women's support systems. In contrast to women in-care, most out-of-care women lacked emotional and financial support from male partners, received minimal counseling from providers at initiation, lacked designated guardians to assist with medication refills or clinic appointments, and were highly mobile. Mobility led to difficulties in accessing treatment in new settings. The most common reasons women re-started treatment following interruptions were due to providers' counseling and encouragement and the mother's desire to be healthy. Improved counseling at initiation, active follow-up counseling, women's economic empowerment interventions, promotion of peer counseling schemes and meaningful engagement of male partners can help in addressing the identified barriers and promoting sustained retention of Option B+ women.
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Affiliation(s)
- Salem Gugsa
- Lighthouse Trust, Lilongwe, Malawi
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
- * E-mail:
| | - Katy Potter
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
| | - Hannock Tweya
- Lighthouse Trust, Lilongwe, Malawi
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Sam Phiri
- Lighthouse Trust, Lilongwe, Malawi
- University of North Carolina, School of Medicine, Department of Medicine, Chapel Hill, North Carolina, United States of America
- University of Malawi, College of Medicine, School of Public Health and Family Medicine, Department of Public Health, Lilongwe, Malawi
| | | | | | - Janet Chikonda
- Ministry of Health, District Health Office, Lilongwe, Malawi
| | - Gabrielle O’Malley
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
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Monroe-Wise A, Mashalla Y, O’Malley G, Nathanson N, Seloilwe E, Gachuno O, Odero T, Nakanjako D, Sewankambo N, Tarimo E, Urassa D, Manabe YC, Chapman S, Voss JG, Wasserheit J, Farquhar C. Training tomorrow's leaders in global health: impact of the Afya Bora Consortium Fellowship on the careers of its alumni. BMC Med Educ 2016; 16:241. [PMID: 27643589 PMCID: PMC5028919 DOI: 10.1186/s12909-016-0750-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/19/2016] [Indexed: 05/30/2023]
Abstract
BACKGROUND Effective leadership is a cornerstone of successful healthcare delivery in resource limited settings throughout the world. However, few programs in Africa prepare healthcare professionals with the leadership skills vital to the success of the healthcare systems in which they work. One such program, the Afya Bora Consortium Fellowship in Global Health Leadership, has been training health professionals since 2011. The purpose of this study was to assess what career changes, if any, the Afya Bora Fellowship's alumni have experienced since completing the fellowship, and to describe those changes. METHODS The Afya Bora Fellowship is a multidisciplinary, one-year training program that teaches health professionals leadership skills through didactic and experiential learning in four African countries. Between January 2011 and June 2013 the consortium trained 42 nurses and doctors. In November 2013, an electronic survey was sent to all alumni to assess their performance in the workplace post-fellowship. RESULTS Thirty-one (74 %) of 42 alumni completed surveys. Twenty-one (68 %) reported changes to their position at work; of those, sixteen (76 %) believed the change was due to participation in the fellowship. All alumni reported improved performance at work, and cited the application of a wide range of fellowship skills, including leadership, research, communication, and mentoring. Twenty-six (84 %) alumni spearheaded improvements in their workplaces and almost all (97 %) remained in contact with colleagues from the fellowship. Among the respondents there were five publications, nine manuscripts in preparation, and three international conference presentations. CONCLUSIONS Afya Bora alumni overwhelmingly reported that the one year fellowship positively influenced both their work and career trajectory. Training health professionals in leadership skills through didactic modules with the opportunity to apply learned skills at attachment sites in the Afya Bora Fellowship has an impact on performance in the workplace and the potential to improve long-term institutional capacity.
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Affiliation(s)
- Aliza Monroe-Wise
- Departments of Medicine and Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104-2499 USA
| | - Yohana Mashalla
- Department of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Neal Nathanson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Esther Seloilwe
- School of Nursing, University of Botswana, Gaborone, Botswana
| | - Onesmus Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Theresa Odero
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Damalie Nakanjako
- Department of Internal Medicine, Makerere University, Kampala, Uganda
| | | | - Edith Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - David Urassa
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yukari C. Manabe
- Department of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Susan Chapman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA USA
| | - Joachim G. Voss
- School of Nursing, University of Washington, Seattle, WA USA
| | - Judith Wasserheit
- Departments of Medicine and Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104-2499 USA
| | - Carey Farquhar
- Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA USA
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Newman L, Mashalla Y, O’Malley G, Seloilwe E, Gachuno O, Odero T, Urassa D, Tarimo E, Nakanjako D, Sewankambo N, Manabe Y, Ousman K, Chapman S, Polomano R, Wiebe D, Voss J, Wasserheit J, Farquhar C. Leadership training to build sustainable workforces and improve health in
Africa. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ousman K, Polomano RC, Seloilwe E, Odero T, Tarimo E, Mashalla YJ, Voss JG, O’Malley G, Chapman SA, Gachuno O, Manabe Y, Nakanjako D, Sewankambo N, Urassa D, Wasserheit JN, Wiebe DJ, Green W, Farquhar C. Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium. J Assoc Nurses AIDS Care 2016; 27:331-43. [PMID: 27086192 PMCID: PMC4834555 DOI: 10.1016/j.jana.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/29/2016] [Indexed: 02/03/2023]
Abstract
HIV continues to challenge health systems, especially in low- and middle-income countries in Sub-Saharan Africa. A qualified workforce of transformational leaders is required to strengthen health systems and introduce policy reforms to address the barriers to HIV testing, treatment, and other HIV services. The 1-year Afya Bora Consortium Fellowship in Global Health capitalizes on academic partnerships between African and U.S. universities to provide interprofessional leadership training through classroom, online, and service-oriented learning in 5 countries in Africa. This fellowship program prepares health professionals to design, implement, scale-up, evaluate, and lead health programs that are population-based and focused on prevention and control of HIV and other public health issues of greatest importance to African communities and health service settings. Afya Bora nurse fellows acquire leadership attributes and competencies that are continuously and systematically tested during the entire program. This multinational training platform promotes interprofessional networks and career opportunities for nurses.
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Affiliation(s)
- Kevin Ousman
- Principal Partner, African Health Resource Group, Baltimore, Maryland, USA
| | - Rosemary C. Polomano
- Professor of Pain Practice, University of Pennsylvania School of Nursing, and Professor of Anesthesiology and Critical Care (Secondary), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Esther Seloilwe
- Associate Professor, School of Nursing University of Botswana, Gaborone, Botswana
| | - Theresa Odero
- Senior Lecturer, School of Nursing Sciences, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Edith Tarimo
- Senior Lecturer, Department of Nursing Management, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yohana J. Mashalla
- Dean, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Joachim G. Voss
- Professor and Director, Sarah Cole Hirsh Center for Evidence Based Practice, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Gabrielle O’Malley
- Assistant Professor, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Susan A. Chapman
- Associate Professor, Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
| | - Onesmus Gachuno
- Senior Lecturer, Department of Obstetrics and Gynecology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Yukari Manabe
- Associate Professor, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Damalie Nakanjako
- Associate Professor, Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Sewankambo
- Principal, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Urassa
- Associate Dean, Department of Community Health, College of Health Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Judith N. Wasserheit
- Chair, Department of Global Health, and Professor of Global Health & Medicine, University of Washington, Seattle, Washington, USA
| | - Douglas J. Wiebe
- Associate Professor, Departments of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy Green
- Assistant Professor, Counseling, Administration, Supervision & Adult Learning, Cleveland State University, Cleveland, Ohio, USA
| | - Carey Farquhar
- Director and Professor, Departments of Medicine, Epidemiology, and Global Health, School of Medicine, University of Washington, Seattle, Washington, USA
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MacLachlan EW, Potter K, Hamunime N, Shepard-Perry MG, Uusiku J, Simwanza R, Brandt LJ, O’Malley G. "We Are Now Free to Speak": Qualitative Evaluation of an Education and Empowerment Training for HIV Patients in Namibia. PLoS One 2016; 11:e0153042. [PMID: 27054712 PMCID: PMC4824517 DOI: 10.1371/journal.pone.0153042] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 03/22/2016] [Indexed: 11/19/2022] Open
Abstract
Although numerous studies provide evidence that active patient engagement with health care providers improves critical outcomes such as medication adherence, very few of these have been done in low resource settings. In Namibia, patient education and empowerment trainings were conducted in four antiretroviral (ART) clinics to increase patient engagement during patient-provider interactions. This qualitative study supplements findings from a randomized controlled trial, by analyzing data from 10 in-depth patient interviews and 94 training evaluation forms. A blended approach of deductive and inductive coding was used to understand training impact. Findings indicated the trainings increased patients’ self-efficacy through a combination of improved HIV-related knowledge, greater communication skills and enhanced ability to overcome complex psychosocial barriers, such as fear of speaking up to providers. This study suggests patient empowerment training may be a powerful method to engage HIV patients in their own care and treatment.
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Affiliation(s)
- Ellen W. MacLachlan
- PATH, Reproductive Health Program, Seattle, Washington, United States of America
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
| | - Katy Potter
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
| | - Ndapewa Hamunime
- Namibia Ministry of Health and Social Services (MoHSS), Windhoek, Namibia
| | - Mark G. Shepard-Perry
- International Training and Education Center for Health (I-TECH) Namibia, Windhoek, Namibia
| | - James Uusiku
- International Training and Education Center for Health (I-TECH) Namibia, Windhoek, Namibia
| | - Ricky Simwanza
- Namibia Ministry of Health and Social Services (MoHSS), Windhoek, Namibia
| | - Laura J. Brandt
- International Training and Education Center for Health (I-TECH) Namibia, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
- * E-mail:
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Thivel D, Isacco L, O’Malley G, Duché P. Pediatric Obesity and Perceived Exertion: Difference Between Weight-Bearing and Non-Weight-Bearing Exercises Performed at Different Intensities. J Sports Sci 2015; 34:389-94. [DOI: 10.1080/02640414.2015.1061200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stamm T, Becker D, Sondergeld L, Wiethoff K, Hiemke C, O’Malley G, Ricken R, Bauer M, Adli M. Prediction of Antidepressant Response to Venlafaxine by a Combination of Early Response Assessment and Therapeutic Drug Monitoring. Pharmacopsychiatry 2014; 47:174-9. [DOI: 10.1055/s-0034-1383565] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- T. Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - D. Becker
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - L. Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - K. Wiethoff
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - C. Hiemke
- Department of Psychiatry and Psychotherapy, Universitätsmedizin Mainz, Germany
| | - G. O’Malley
- School of Psychology, University College Dublin, Ireland
| | - R. Ricken
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - M. Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M. Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Daniels J, Farquhar C, Nathanson N, Mashalla Y, Petracca F, Desmond M, Green W, Davies L, O’Malley G, Bollinger B, Farquhar C, Gachuno O, Glass N, Kaaya E, Mashalla Y, Muecke M, Nakanjako D, Nathanson N, Odero T, Seloilwe E, Sewankambo N, Stewart C, Urassa D, Voss J, Wasserheit JN. Training tomorrow’s global health leaders: applying a transtheoretical model to identify behavior change stages within an intervention for health leadership development. Glob Health Promot 2014; 21:24-34. [DOI: 10.1177/1757975914528726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Training health professionals in leadership and management skills is a key component of health systems strengthening in low-resource settings. The importance of evaluating the effectiveness of these programs has received increased attention over the past several years, although such evaluations continue to pose significant challenges. This article presents evaluation data from the pilot year of the Afya Bora Fellowship, an African-based training program to increase the leadership capacity of health professionals. Firstly, we describe the goals of the Afya Bora Fellowship. Then, we present an adaptation of the transtheoretical model for behavior change called the Health Leadership Development Model, as an analytical lens to identify and describe evidence of individual leadership behavior change among training participants during and shortly after the pilot year of the program. The Health Leadership Development Model includes the following: pre-contemplation (status quo), contemplation (testing and internalizing leadership), preparation – (moving toward leadership), action (leadership in action), and maintenance (effecting organizational change). We used data from surveys, in-depth interviews, journal entries and course evaluations as data points to populate the Health Leadership Development Model. In the short term, fellows demonstrated increased leadership development during and shortly after the intervention and reflected the contemplation, preparation and action stages of the Health Leadership Development Model. However, expanded interventions and/or additional time may be needed to support behavior change toward the maintenance stages. We conclude that the Health Leadership Development Model is useful for informing health leadership training design and evaluation to contribute to sustainable health organizational change.
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Affiliation(s)
- Joseph Daniels
- Department of Global Health, University of Washington, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, USA
- Department of Epidemiology, University of Washington, USA
- Department of Medicine, University of Washington, USA
| | - Neal Nathanson
- Global Health Programs, School of Medicine, University of Pennsylvania, USA
| | - Yohana Mashalla
- Department of Physiology, School of Medicine, University of Botswana, Botswana
| | | | | | - Wendy Green
- College of Education, University of Pennsylvania, USA
| | - Luke Davies
- Department of Global Health, University of Washington, USA
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O’Malley G, Asrat L, Sharma A, Hamunime N, Stephanus Y, Brandt L, Ali D, Kaindjee-Tjituka F, Natanael S, Gweshe J, Feldacker C, Shihepo E. Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action. PLoS One 2014; 9:e92014. [PMID: 24642894 PMCID: PMC3958436 DOI: 10.1371/journal.pone.0092014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 09/27/2013] [Accepted: 02/19/2014] [Indexed: 11/18/2022] Open
Abstract
Background Evidence from several sub-Saharan countries support nurse-initiated antiretroviral treatment as a feasible alternative to doctor-led models characteristic of early responses to the HIV epidemic. However, service delivery models shown to be effective in one country may not be readily adopted in another. This study used an implementation research approach to assist policy makers and other stakeholders to assess the acceptability and feasibility of task shifting in the Namibian context. Methods The Namibian Ministry of Health and Social Services implemented a Task Shifting Demonstration Project (TSDP) at 9 sites at different levels of the health system. Six months after implementation, a mixed methods evaluation was conducted. Seventy semi-structured interviews were conducted with patients, managers, doctors and nurses directly involved with the TSDP. Physician-evaluators observed and compared health service provision between doctors and nurses for 40 patients (80 observations), documenting performance in agreement with the national guidelines on 13 clinical care indicators. Results Doctors, nurses, and patients interviewed believed task shifting would improve access to and quality of HIV services. Doctors and nurses both reported an increase in nurses’ skills as a result of the project. Observation data showed doctors and nurses were in considerable agreement (>80%) with each other on all dimensions of HIV care and ≥90% on eight dimensions. To ensure success of national scale-up of the task shifting model, challenges involving infrastructure, on-going mentoring, and nursing scope of practice should be anticipated and addressed. Conclusion In combination with findings from other studies in the region, data from the TSDP provided critical and timely information to the Namibian Ministry of Health and Social Services, thus helping to move evidence into action. Small-scale implementation research projects enable stakeholders to learn by doing, and provide an opportunity to test and modify the intervention before expansion.
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Affiliation(s)
- Gabrielle O’Malley
- International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Lily Asrat
- International Training and Education Center for Health, University of Washington, Windhoek, Namibia
| | - Anjali Sharma
- International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
| | - Ndapewa Hamunime
- Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Yvonne Stephanus
- International Training and Education Center for Health, University of Washington, Windhoek, Namibia
| | - Laura Brandt
- International Training and Education Center for Health, University of Washington, Windhoek, Namibia
| | - Deqa Ali
- International Training and Education Center for Health, University of Washington, Windhoek, Namibia
| | | | - Salomo Natanael
- Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Justice Gweshe
- Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Caryl Feldacker
- International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
| | - Ella Shihepo
- Namibia Ministry of Health and Social Services, Windhoek, Namibia
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O’Malley G, Perdue T, Petracca F. A framework for outcome-level evaluation of in-service training of health care workers. Hum Resour Health 2013; 11:50. [PMID: 24083635 PMCID: PMC3851191 DOI: 10.1186/1478-4491-11-50] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 02/18/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND In-service training is a key strategic approach to addressing the severe shortage of health care workers in many countries. However, there is a lack of evidence linking these health care worker trainings to improved health outcomes. In response, the United States President's Emergency Plan for AIDS Relief's Human Resources for Health Technical Working Group initiated a project to develop an outcome-focused training evaluation framework. This paper presents the methods and results of that project. METHODS A general inductive methodology was used for the conceptualization and development of the framework. Fifteen key informant interviews were conducted to explore contextual factors, perceived needs, barriers and facilitators affecting the evaluation of training outcomes. In addition, a thematic analysis of 70 published articles reporting health care worker training outcomes identified key themes and categories. These were integrated, synthesized and compared to several existing training evaluation models. This formed an overall typology which was used to draft a new framework. Finally, the framework was refined and validated through an iterative process of feedback, pilot testing and revision. RESULTS The inductive process resulted in identification of themes and categories, as well as relationships among several levels and types of outcomes. The resulting framework includes nine distinct types of outcomes that can be evaluated, which are organized within three nested levels: individual, organizational and health system/population. The outcome types are: (1) individual knowledge, attitudes and skills; (2) individual performance; (3) individual patient health; (4) organizational systems; (5) organizational performance; (6) organizational-level patient health; (7) health systems; (8) population-level performance; and (9) population-level health. The framework also addresses contextual factors which may influence the outcomes of training, as well as the ability of evaluators to determine training outcomes. In addition, a group of user-friendly resources, the Training Evaluation Framework and Tools (TEFT) were created to help evaluators and stakeholders understand and apply the framework. CONCLUSIONS Feedback from pilot users suggests that using the framework and accompanying tools may support outcome evaluation planning. Further assessment will assist in strengthening guidelines and tools for operationalization.
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Affiliation(s)
- Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, 901 Boren Avenue, Suite 1100, Seattle, WA 98104, USA
| | - Thomas Perdue
- International Training and Education Center for Health, Department of Global Health, University of Washington, 901 Boren Avenue, Suite 1100, Seattle, WA 98104, USA
| | - Frances Petracca
- International Training and Education Center for Health, Department of Global Health, University of Washington, 901 Boren Avenue, Suite 1100, Seattle, WA 98104, USA
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O’Malley G, Marseille E, Weaver MR. Cost-effectiveness analyses of training: a manager's guide. Hum Resour Health 2013; 11:20. [PMID: 23688059 PMCID: PMC3684521 DOI: 10.1186/1478-4491-11-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 04/19/2013] [Indexed: 06/02/2023]
Abstract
The evidence on the cost and cost-effectiveness of global training programs is sparse. This manager's guide to cost-effectiveness analysis (CEA) is for professionals who want to recognize and support high quality CEA. It focuses on CEA of training in the context of program implementation or rapid program expansion. Cost analysis provides cost per output and CEA provides cost per outcome. The distinction between these two analyses is essential for making good decisions about value. A hypothetical example of a cost analysis compares the cost per trainee of a computer-based anti-retroviral therapy (ART) training to a more intensive ART training. In a CEA of the same example, cost per trainee who met ART clinical performance standards is compared. The cost analysis is misleading when the effectiveness differs across trainings. Two additional hypothetical examples progress from simple to more complex costs and from a narrow to a broader scope: 1) CEA of the cost per ART patient with 95% adherence that compares the performance of doctors to counselors who attend additional training, and 2) CEA of the cost per infant HIV infection averted for a Prevention of Mother to Child Transmission program that compares the current program to one with additional training. To create an evidence base on CEA of training, more well-designed analyses and data on the cost of training are needed. Analysts should understand more about how capacity is built, how quality is improved within a health facility, and the costs associated with them. Considering the life of an investment in training, evaluations are needed on how many trainees apply the skills taught, how long trainees continue to apply them, and how long the content of the training conforms to national or international guidelines. Better data on effectiveness of training is also needed. It is feasible to measure effectiveness by clinical performance standards, or intermediate outcomes and coverage. Intermediate outcomes and coverage can also be combined with published estimates on health outcomes.
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Affiliation(s)
- Gabrielle O’Malley
- Department of Global Health, International Training and Education Center for Health, University of Washington, 901 Boren, Suite 1100, Seattle, WA, USA
| | - Elliot Marseille
- Health Strategies International, 555 59th Street, Oakland, CA, 94609, USA
| | - Marcia R Weaver
- Department of Global Health, International Training and Education Center for Health, University of Washington, 901 Boren, Suite 1100, Seattle, WA, USA
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O’Malley G, Mulkerrin E. Vitamin D insufficiency: a common and treatable problem in the Irish population. Ir J Med Sci 2010; 180:7-13. [DOI: 10.1007/s11845-010-0512-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 05/20/2010] [Indexed: 12/31/2022]
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Byers S, O’Malley G, Alli F, Dominici P. 126. Ann Emerg Med 2006. [DOI: 10.1016/j.annemergmed.2006.07.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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