1
|
Wu L, Kinuthia J, Anderson PL, Baeten JM, Dettinger JC, Gandhi M, Gomez L, John-Stewart G, Marwa MM, Ngumbau N, Otieno F, Omondi P, Odhiambo B, Watoyi S, Pintye J. Drug concentrations in hair and dried blood spots as PrEP adherence metrics during pregnancy and postpartum. J Infect Dis 2024:jiae208. [PMID: 38700101 DOI: 10.1093/infdis/jiae208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
We evaluated hair tenofovir (TFV) concentrations as an adherence metric for HIV pre-exposure prophylaxis (PrEP) during pregnancy and postpartum and compared hair levels with tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS). Overall, 152 hair samples from 102 women and 36 hair-DBS paired samples from 29 women were collected from a subset of women in a cluster randomized trial. Having a partner known to be living with HIV was associated with higher hair TFV levels (p<0.001). Hair TFV concentrations were strongly correlated with DBS TFV-DP levels (r=0.76, p<0.001), indicating hair as promising cumulative adherence metric for perinatal PrEP assessment.
Collapse
Affiliation(s)
- Linxuan Wu
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Peter L Anderson
- Department of Pharmaceutical Sciences Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Jared M Baeten
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laurén Gomez
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Mary M Marwa
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Ngumbau
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Otieno
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Pascal Omondi
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Ben Odhiambo
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Salphine Watoyi
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA
| |
Collapse
|
2
|
Njuguna I, Saidi F, Joseph Davey D, Chi BH, Pintye J. Editorial: Improving the delivery of pre-exposure prophylaxis (PrEP) to eliminate vertical HIV transmission. Front Reprod Health 2024; 6:1382548. [PMID: 38689754 PMCID: PMC11058988 DOI: 10.3389/frph.2024.1382548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Irene Njuguna
- Department of Medical Research, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Friday Saidi
- UNC Project Malawi, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Obstetrics and Gynecology, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Dvora Joseph Davey
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Department of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Benjamin H. Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
3
|
Roche SD, Were D, Crawford ND, Tembo A, Pintye J, Bukusi E, Ngure K, Ortblad KF. Getting HIV Pre-exposure Prophylaxis (PrEP) into Private Pharmacies: Global Delivery Models and Research Directions. Curr HIV/AIDS Rep 2024:10.1007/s11904-024-00696-y. [PMID: 38517671 DOI: 10.1007/s11904-024-00696-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW To provide an overview of the current state of HIV pre-exposure prophylaxis (PrEP) delivery via private sector pharmacies globally, to discuss the context-specific factors that have influenced the design and implementation of different pharmacy-based PrEP delivery models in three example settings, and to identify future research directions. RECENT FINDINGS Multiple high- and low-income countries are implementing or pilot testing PrEP delivery via private pharmacies using a variety of delivery models, tailored to the context. Current evidence indicates that pharmacy-based PrEP services are in demand and generally acceptable to clients and pharmacy providers. Additionally, the evidence suggests that with proper training and oversight, pharmacy providers are capable of safely initiating and managing clients on PrEP. The delivery of PrEP services at private pharmacies also achieves similar levels of PrEP initiation and continuation as traditional health clinics, but additionally reach individuals underserved by such clinics (e.g., young men; minorities), making pharmacies well-positioned to increase overall PrEP coverage. Implementation of pharmacy-based PrEP services will look different in each context and depend not only on the state of the private pharmacy sector, but also on the extent to which key needs related to governance, financing, and regulation are addressed. Private pharmacies are a promising delivery channel for PrEP in diverse settings. Countries with robust private pharmacy sectors and populations at HIV risk should focus on aligning key areas related to governance, financing, and regulation that have proven critical to pharmacy-based PrEP delivery while pursuing an ambitious research agenda to generate information for decision-making. Additionally, the nascency of pharmacy-based PrEP delivery in both high- and low-and-middle-income settings presents a prime opportunity for shared learning and innovation.
Collapse
Affiliation(s)
- Stephanie D Roche
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | | | - Natalie D Crawford
- Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Angela Tembo
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jillian Pintye
- School of Nursing, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, USA
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Katrina F Ortblad
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| |
Collapse
|
4
|
Secor AM, Ihnatiuk A, Shapoval A, McDowell M, Hetman L, Wagner AD, Pintye J, Beima-Sofie K, Golden MR, Puttkammer N. Does HIV index testing bring patients into treatment at earlier stages of HIV disease? Results from a retrospective study in Ukraine. BMC Infect Dis 2024; 24:328. [PMID: 38500055 PMCID: PMC10949801 DOI: 10.1186/s12879-024-09190-7] [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: 12/10/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Over one-third of people living with HIV (PLH) in Ukraine are not on treatment. Index testing services, which link potentially exposed partners (named partners) of known PLH (index patients) with testing and treatment services, are being scaled in Ukraine and could potentially close this gap. METHODS This retrospective study included patient data from 14,554 adult PLH who initiated antiretroviral treatment (ART) between October 2018 and May 2021 at one of 35 facilities participating in an intervention to strengthen index testing services. Mixed effects modified Poisson models were used to assess differences between named partners and other ART initiators, and an interrupted time series (ITS) analysis was used to assess changes in ART initiation over time. RESULTS Compared to other ART initiators, named partners were significantly less likely to have a confirmed TB diagnosis (aRR = 0.56, 95% CI = 0.40, 0.77, p < 0.001), a CD4 count less than 200 cells/mm3 (aRR = 0.84, 95% CI = 0.73, 0.97, p = 0.017), or be categorized as WHO HIV stage 4 (aRR = 0.68, 9% CI = 0.55, 0.83, p < 0.001) at the time of ART initiation, and were significantly more likely to initiate ART within seven days of testing for HIV (aRR = 1.36, 95% CI = 1.22, 1.50, p < 0.001). Our ITS analysis showed a modest 2.34% (95% CI = 0.26%, 4.38%; p = 0.028) month-on-month reduction in mean ART initiations comparing the post-intervention period to the pre-intervention period, although these results were likely confounded by the COVID epidemic. CONCLUSION Our findings suggest that index testing services may be beneficial in bringing PLH into treatment at an earlier stage of HIV disease and decreasing delays between HIV testing and ART initiation, potentially improving patient outcomes and retention in the HIV care cascade.
Collapse
Affiliation(s)
- Andrew M Secor
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA.
| | - Alyona Ihnatiuk
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Anna Shapoval
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Misti McDowell
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
| | - Larisa Hetman
- Public Health Center (PHC) of the Ministry of Health (MoH) of Ukraine, Kyiv, Ukraine
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Nancy Puttkammer
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
| |
Collapse
|
5
|
Secor AM, Célestin K, Jasmin M, Honoré JG, Wagner AD, Beima-Sofie K, Pintye J, Puttkammer N. Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy Among Adults and Children Living With HIV in Haiti: Retrospective Longitudinal Study. JMIR Pediatr Parent 2024; 7:e51574. [PMID: 38488632 PMCID: PMC10986334 DOI: 10.2196/51574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Children (aged 0-14 years) living with HIV often experience lower rates of HIV diagnosis, treatment, and viral load suppression. In Haiti, only 63% of children living with HIV know their HIV status (compared to 85% overall), 63% are on treatment (compared to 85% overall), and 48% are virally suppressed (compared to 73% overall). Electronic medical records (EMRs) can improve HIV care and patient outcomes, but these benefits are largely dependent on providers having access to quality and nonmissing data. Objective We sought to understand the associations between EMR data missingness and interruption in antiretroviral therapy treatment by age group (pediatric vs adult). Methods We assessed associations between patient intake record data missingness and interruption in treatment (IIT) status at 6 and 12 months post antiretroviral therapy initiation using patient-level data drawn from iSanté, the most widely used EMR in Haiti. Missingness was assessed for tuberculosis diagnosis, World Health Organization HIV stage, and weight using a composite score indicator (ie, the number of indicators of interest missing). Risk ratios were estimated using marginal parameters from multilevel modified Poisson models with robust error variances and random intercepts for the facility to account for clustering. Results Data were drawn from 50 facilities and comprised 31,457 patient records from people living with HIV, of which 1306 (4.2%) were pediatric cases. Pediatric patients were more likely than adult patients to experience IIT (n=431, 33% vs n=7477, 23.4% at 6 months; P<.001). Additionally, pediatric patient records had higher data missingness, with 581 (44.5%) pediatric records missing at least 1 indicator of interest, compared to 7812 (25.9%) adult records (P<.001). Among pediatric patients, each additional indicator missing was associated with a 1.34 times greater likelihood of experiencing IIT at 6 months (95% CI 1.08-1.66; P=.008) and 1.24 times greater likelihood of experiencing IIT at 12 months (95% CI 1.05-1.46; P=.01). These relationships were not statistically significant for adult patients. Compared to pediatric patients with 0 missing indicators, pediatric patients with 1, 2, or 3 missing indicators were 1.59 (95% CI 1.26-2.01; P<.001), 1.74 (95% CI 1.02-2.97; P=.04), and 2.25 (95% CI 1.43-3.56; P=.001) times more likely to experience IIT at 6 months, respectively. Among adult patients, compared to patients with 0 indicators missing, having all 3 indicators missing was associated with being 1.32 times more likely to experience IIT at 6 months (95% CI 1.03-1.70; P=.03), while there was no association with IIT status for other levels of missingness. Conclusions These findings suggest that both EMR data quality and quality of care are lower for children living with HIV in Haiti. This underscores the need for further research into the mechanisms by which EMR data quality impacts the quality of care and patient outcomes among this population. Efforts to improve both EMR data quality and quality of care should consider prioritizing pediatric patients.
Collapse
Affiliation(s)
- Andrew M Secor
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kemar Célestin
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Margareth Jasmin
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - 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 Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- International Training and Education Center for Health, Seattle, WA, United States
| |
Collapse
|
6
|
Ngumbau NM, Neary J, Wagner AD, Abuna F, Ochieng B, Dettinger JC, Gómez L, Marwa MM, Watoyi S, Nzove E, Pintye J, Baeten JM, Kinuthia J, John-Stewart G. Cofactors of Partner HIV Self-testing and Oral PrEP Acceptance Among Pregnant Women at High Risk of HIV in Kenya. J Acquir Immune Defic Syndr 2024; 95:238-245. [PMID: 38408215 PMCID: PMC10897494 DOI: 10.1097/qai.0000000000003355] [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: 02/28/2023] [Accepted: 11/06/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Oral pre-exposure prophylaxis (PrEP) and male partner HIV self-testing (HIVST) is being scaled up within antenatal clinics. Few data are available on how co-distribution influences acceptance of both interventions. METHODS We used data from the PrEP Implementation of Mothers in Antenatal Care (NCT03070600) trial in Kenya. Women included in this analysis were determined to be at high risk of HIV and offered oral PrEP and partner HIVST. Characteristics were compared between women who chose: (1) PrEP and HIVST, (2) HIVST-alone, (3) PrEP-alone, or (4) declined both (reference), excluding women who had partners known to be living with HIV. RESULTS Among 911 women, median age was 24 years, 87.3% were married, 43.9% perceived themselves to be at high risk of HIV and 13.0% had history of intimate partner violence (IPV). Overall, 68.9% accepted HIVST and 18.4% accepted PrEP, with 54.7% accepting HIVST-alone, 4.2% PrEP-alone, and 14.3% both HIVST and PrEP. Of women accepting HIVST, partner HIV testing increased from 20% to 82% and awareness of partner HIV status increased from 4.7% to 82.0% between pregnancy and 9 months postpartum (P < 0.001). Compared with women who accepted neither, choosing: (1) HIVST-alone was associated with being married, higher level of education, and residing with partner; (2) PrEP-alone was associated with lower social support, IPV, not residing with partner, longer time living with partner, and suspicion of other partners; and (3) PrEP and HIVST was associated with being married, IPV, and suspicion that partner had other partners. CONCLUSIONS Understanding factors associated with accepting HIVST and PrEP can inform HIV prevention programs for pregnant women. CLINICAL TRIAL NUMBER NCT03070600.
Collapse
Affiliation(s)
- Nancy M Ngumbau
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Felix Abuna
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Ben Ochieng
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Mary M Marwa
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Salphine Watoyi
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | - John Kinuthia
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology
- Department of Global Health
- Departments of Pediatrics and Medicine, University of Washington, Seattle, WA
| |
Collapse
|
7
|
Mogaka JN, Drake AL, Matemo D, Kinuthia J, McClelland RS, Unger JA, Richardson BA, John-Stewart G, Pintye J. Prevalence and Predictors of Chlamydia trachomatis and Neisseria gonorrhoeae Among HIV-Negative Pregnant Women in Kenya. Sex Transm Dis 2024; 51:65-71. [PMID: 37889941 DOI: 10.1097/olq.0000000000001881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in pregnancy contribute to adverse perinatal outcomes. We identified predictors of CT and/or NG infection among pregnant Kenyan women. METHODS Women without HIV were enrolled at 2 antenatal clinics in Western Kenya. Both CT and NG were assessed using endocervical samples for nucleic acid amplification tests. Poisson regression models were used to evaluate potential CT/NG risk factors. Classification and regression trees were generated to evaluate the joint effects of predictors. RESULTS Overall, 1276 women had both CT and NG assessments. Women enrolled at a median of 26 weeks' gestation (interquartile range, 22-31 weeks), median age was 22 years (interquartile range, 19-27 years), and 78% were married. In total, 98 (7.7%) tested positive for CT/NG: 70 (5.5%) for CT and 32 (2.5%) for NG, 4 of whom (0.3%) had coinfections. Two-thirds (66%) of CT/NG cases were asymptomatic and would have been missed with only syndromic management. Risk factors of CT/NG included age <22 years, crowded living conditions, being unmarried, being in partnerships for <1 year, abnormal vaginal discharge, sexually transmitted infection history, and Trichomonas vaginalis diagnosis ( P < 0.1). Classification and regression tree analyses identified unmarried women <22 years in relationships for <1 year as 6.1 times more likely to have CT/NG compared with women without these characteristics (26% vs. 6%, adjusted prevalence ratio = 6.1, 95% confidence interval = 3.55-10.39, P < 0.001). CONCLUSIONS Chlamydia trachomatis / Neisseria gonorrhoeae was frequently asymptomatic and common among young unmarried women in newer partnerships in this cohort. Integrating CT/NG testing into routine antenatal care may be beneficial, especially for young women in Kenya.
Collapse
|
8
|
O'Connor MR, Beard KV, van Ryn M, Inevil SG, Palacios L, Strauss A, Acosta A, Rustan K, Willgerodt M, Pintye J, Hulick J, Hirsch A, de Castro B. Using equityXdesign to Develop Nursing Curricula : The Implicit Bias Clinical Teaching Program Case Study. Nurse Educ 2024; 49:57-59. [PMID: 37537707 PMCID: PMC10720775 DOI: 10.1097/nne.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023]
Affiliation(s)
- M. Rebecca O'Connor
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Kenya V. Beard
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Michelle van Ryn
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Samuelle G. Inevil
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Liliana Palacios
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Amelia Strauss
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Adrian Acosta
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Keondra Rustan
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Mayumi Willgerodt
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Jillian Pintye
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Johanna Hulick
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Anne Hirsch
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| | - Butch de Castro
- Associate Professor (Drs O'Connor and Pintye), Doctor of Nursing Practice Students (Drs Inevil, Palacios, and Strauss), Professor (Drs de Castro, Hirsch, and Willgerodt), Undergraduate Advisor (Mr Acosta), Assistant Director Simulation Center (Dr Rustan), and Teaching Associate (Ms Hulick), School of Nursing, University of Washington, Seattle; Associate Provost (Dr Beard), Social Mission and Academic Excellence, Chamberlain University, Chicago, Illinois; and Founder, Distinguished Scientist (Dr van Ryn), Diversity Science, Clackamas, Oregon
| |
Collapse
|
9
|
Kangethe JM, Gichuhi S, Odari E, Pintye J, Mutai K, Abdullahi L, Maiyo A, Mureithi MW. Confronting the human papillomavirus-HIV intersection: Cervical cytology implications for Kenyan women living with HIV. South Afr J HIV Med 2023; 24:1508. [PMID: 37928501 PMCID: PMC10623654 DOI: 10.4102/sajhivmed.v24i1.1508] [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: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background High-risk human papillomavirus (HR-HPV) is the primary cause of cervical cancer, leading to over 311 000 global deaths, mainly in low- and middle-income countries. Kenyan women living with HIV (WLHIV) face a disproportionate burden of HR-HPV. Objectives We determined the prevalence of HR-HPV infections and their association with cervical cytology findings among Kenyan WLHIV. Method We conducted a cross-sectional study among WLHIV attending the HIV care and treatment clinic at the Kenyatta National Hospital (KNH), Kenya's national referral hospital. Study nurses collected a cervical sample with a cytobrush for HR-HPV genotyping using Gene Xpert® assays and HPV Genotypes 14 Real-TM Quant V67-100FRT. Bivariate analysis explored the associations. Results We enrolled 647 WLHIV (mean age of 42.8 years), with 97.2% on antiretroviral therapy (ART) and 79% with a suppressed viral load (< 50 copies/mL plasma). The prevalence of any and vaccine-preventable HR-HPV was 34.6% and 29.4%, respectively, with HPV 52 being the most common genotype (13.4%). Among WLHIV with HR-HPV infections, 21.4% had abnormal cervical cytology. Women with multiple HR-HPV infections were more likely to have abnormal cytology compared to those with single HR-HPV infections (34.9 vs 9.3%, adjusted odds ratio [aOR] = 6.2, 95% confidence interval [CI]: 2.7-14.1, P = 0.001). Women with HR-HPV infection (single or multiple) were more likely to be on the second-line ART regimen compared to those without HR-HPV infections (53.1% vs 46.7%, aOR = 2.3, 95% CI: 1.3-4.1, P = 0.005). Conclusion Among WLHIV at KNH, abnormal cytology was common and more frequent among women with multiple HR-HPV infections.
Collapse
Affiliation(s)
- James M Kangethe
- Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Kenya
- Comprehensive Care Center for HIV, Kenyatta National Hospital, Nairobi, Kenya
| | - Stephen Gichuhi
- Department of Ophthalmology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Eddy Odari
- Department of Medical Microbiology, Faculty of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, United States of America
| | - Kenneth Mutai
- Comprehensive Care Center for HIV, Kenyatta National Hospital, Nairobi, Kenya
| | - Leila Abdullahi
- Research and Policy Development, African Institute for Development Policy, Nairobi, Kenya
| | - Alex Maiyo
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Marianne W Mureithi
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Kenya
- KAVI Institute of Clinical Research, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Pintye J, Kinuthia J, Abuna F, Anderson PL, Dettinger JC, Gomez L, Haberer JE, Marwa MM, Ngumbau N, Omondi P, Odhiambo B, Stern J, Watoyi S, Baeten JM, John-Stewart G. HIV pre-exposure prophylaxis initiation, persistence, and adherence during pregnancy through the postpartum period. AIDS 2023; 37:1725-1737. [PMID: 37289583 PMCID: PMC10527305 DOI: 10.1097/qad.0000000000003617] [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] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We evaluated pre-exposure prophylaxis (PrEP) initiation, persistence, and adherence measured via tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots (DBS) among women offered PrEP during pregnancy. METHODS We prospectively analyzed data from participants in the PrIMA Study (NCT03070600) who were offered PrEP during the second trimester and followed through 9 months postpartum. At follow-up visits (monthly in pregnancy; 6 weeks, 6 months, 9 months postpartum), self-reported PrEP use was assessed, and DBS were collected for quantifying TFV-DP concentrations. RESULTS In total, 2949 participants were included in the analysis. At enrollment, median age was 24 years [interquartile range IQR) 21-29], gestational age 24 weeks (IQR 20-28), and 4% had a known partner living with HIV. Overall, 405 (14%) participants initiated PrEP in pregnancy with higher frequency among those with risk factors for HIV acquisition, including >2 lifetime sexual partners, syphilis during pregnancy, forced sex, and intimate partner violence ( P < 0.05). At 9 months postpartum, 58% of PrEP initiators persisted with PrEP use, of which 54% self-reported not missing any PrEP pills in the last 30 days. Among DBS randomly selected from visits where participants persisted with PrEP ( n = 427), 50% had quantifiable TFV-DP. Quantifiable TFV-DP was twice as likely in pregnancy than postpartum [adjusted risk ratio (aRR) = 1.90, 95% confidence interval (CI) 1.40-2.57, P < 0.001]. Having a partner known to be living with HIV was the strongest predictor of PrEP initiation, persistence, and quantifiable TFV-DP ( P < 0.001). CONCLUSIONS PrEP persistence and adherence waned postpartum, though over half of PrEP initiators persisted through 9-months postpartum. Interventions should prioritize increasing knowledge of partner HIV status and sustaining adherence in the postpartum period.
Collapse
Affiliation(s)
| | - John Kinuthia
- University of Washington, Seattle, Washington, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | - Laurén Gomez
- University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | - Joshua Stern
- University of Washington, Seattle, Washington, USA
| | | | | | | |
Collapse
|
12
|
Larsen A, Pintye J, Abuna F, Bhat A, Dettinger JC, Gomez L, Marwa MM, Ngumbau N, Odhiambo B, Phipps AI, Richardson BA, Watoyi S, Stern J, Kinuthia J, John-Stewart G. Risks of adverse perinatal outcomes in relation to maternal depressive symptoms: A prospective cohort study in Kenya. Paediatr Perinat Epidemiol 2023; 37:489-504. [PMID: 37186316 PMCID: PMC10524238 DOI: 10.1111/ppe.12978] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/02/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Evidence gaps remain regarding the influence of prenatal psychosocial factors on adverse pregnancy outcomes. OBJECTIVE The objective of this study is to evaluate relationships between psychosocial factors and adverse perinatal outcomes among Kenyan women. METHODS We analysed data from a prospective cohort study enrolling HIV-negative women in pregnancy (NCT03070600) in 20 antenatal clinics in Western Kenya. Study nurses assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), social support using the Medical Outcomes Survey scale (MOS-SSS), intimate partner violence (IPV) with the Hurt, Insult, Threaten, Scream scale (HITS), and pregnancy outcomes at 6 weeks postpartum. Cox proportional hazards models were used to evaluate relationships between depressive symptoms (moderate-to-severe [MSD, CESD-10 ≥10] and mild-to-severe [Mild-SD, CESD-10 ≥5]), low social support (MOS-SSS <72), and IPV (HITS ≥10) with adverse perinatal outcomes of pregnancy loss, stillbirth, preterm birth (PTB), small for gestational age, and neonatal mortality. We also estimated the population attributable risk. RESULTS Among 4153 women, 23.9% (n = 994) had MSD, 54.7% (n = 2273) mild-SD, 37.3% (n = 1550) low social support, and 7.8% (n = 323) experienced IPV. Pregnancy loss was 5-fold higher among women with MSD (adjusted hazard ratio [HR] 5.04, 95% confidence interval [CI] 2.44, 10.42); 37.4% of losses were attributable to MSD. Mild-SD was associated with PTB (HR 1.39, 95% CI 1.03, 1.87). Stillbirth risk more than doubled among women reporting low social support (HR 2.37, 95% CI 1.14, 4.94). CONCLUSIONS Adverse perinatal outcomes were common and associated with prenatal depressive symptoms and low social support in this large cohort of Kenyan mother-infant pairs.
Collapse
Affiliation(s)
- Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Services, University of Washington, School of Medicine, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | | | - Amritha Bhat
- Department of Psychiatry and Behavioral Services, University of Washington, School of Medicine, Seattle, WA, USA
| | | | - Laurén Gomez
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Nancy Ngumbau
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Barbra A. Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Joshua Stern
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA
- The University of Nairobi, Nairobi, Kenya
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, School of Medicine, Seattle, WA, USA
| |
Collapse
|
13
|
Marwa MM, Kinuthia J, Larsen A, Dettinger JC, Gomez LA, Awino P, Abuna F, Watoyi S, Ochieng B, Ngumbau N, John-Stewart G, Pintye J. COVID-19 vaccine hesitancy among pregnant and postpartum Kenyan women. Int J Gynaecol Obstet 2023; 162:147-153. [PMID: 37036449 PMCID: PMC10330087 DOI: 10.1002/ijgo.14773] [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] [Received: 08/12/2022] [Revised: 02/04/2023] [Accepted: 03/20/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE The authors evaluated factors contributing to coronavirus disease 2019 (COVID-19) vaccine hesitancy among pregnant and postpartum women to inform vaccine scale-up strategies. METHODS This observational study utilized data from pregnant and postpartum women attending four public maternal child health (MCH) clinics in Western Kenya. From October 2020 to July 2022, nurses assessed COVID-19 vaccine hesitancy, defined as reporting "unlikely" or "very unlikely" to the question, "If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?" RESULTS Among 1023 women (235 pregnant, 788 postpartum), 20% reported worsened MCH care during the pandemic and most (92%) perceived themselves or family members to be at risk for COVID-19, yet 54% of women reported COVID-19 vaccine hesitancy. Vaccine hesitancy was more frequent among women reporting worsened MCH care (P < 0.001) since the pandemic and those who did not trust the government as a source of COVID-19 information (P = 0.016). Over the 2-year period, willingness to receive the vaccine almost doubled (38% to 71%, P < 0.001). CONCLUSIONS Our findings suggest that sustaining access to quality MCH services may decrease COVID-19 vaccine hesitancy. Willingness to receive the vaccine doubled over the 2-year period in our cohort, suggesting increased trust for use and acceptance in the unique context of the pregnancy/postpartum period.
Collapse
Affiliation(s)
- Mary M. Marwa
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - John Kinuthia
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
- University of Washington Department of Global Health
| | - Ann Larsen
- University of Washington, Department of Epidemiology
| | | | | | - Pascal Awino
- University of Washington Department of Global Health
| | - Felix Abuna
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - Salphine Watoyi
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - Ben Ochieng
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - Nancy Ngumbau
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - Grace John-Stewart
- University of Washington, Department of Epidemiology
- University of Washington Department of Global Health
- University of Washington, School of Medicine, Department of Pediatrics
- University of Washington, School of Medicine, Department of Psychiatry & Behavioral Services
| | - Jillian Pintye
- University of Washington Department of Global Health
- University of Washington, Department of Biobehavioral Nursing and Health Informatics
| |
Collapse
|
14
|
Wara NJ, Mvududu R, Marwa MM, Gómez L, Mashele N, Orrell C, Moucheraud C, Kinuthia J, John-Stewart G, Myer L, Hoffman R, Pintye J, Davey DLJ. Preferences and acceptability for long-acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya. J Int AIDS Soc 2023; 26:e26088. [PMID: 37221983 DOI: 10.1002/jia2.26088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Long-acting pre-exposure prophylaxis (PrEP) options could overcome barriers to oral PrEP persistence during pregnancy and postpartum. We evaluated long-acting PrEP preferences among oral PrEP-experienced pregnant and postpartum women in South Africa and Kenya, countries with high PrEP coverage with pending regulatory approvals for long-acting injectable cabotegravir and the dapivirine vaginal ring (approved in South Africa, under review in Kenya). METHODS From September 2021 to February 2022, we surveyed pregnant and postpartum women enrolled in oral PrEP studies in South Africa and Kenya. We evaluated oral PrEP attitudes and preferences for long-acting PrEP methods in multivariable logistic regression models adjusting for maternal age and country. RESULTS We surveyed 190 women in South Africa (67% postpartum; median age 27 years [IQR = 22-32]) and 204 women in Kenya (79% postpartum; median age 29 years [IQR = 25-33]). Seventy-five percent of participants reported oral PrEP use within the last 30 days. Overall, forty-nine percent of participants reported negative oral PrEP attributes, including side effects (21% South Africa, 30% Kenya) and pill burden (20% South Africa, 25% Kenya). Preferred PrEP attributes included long-acting method, effectiveness, safety while pregnant and breastfeeding, and free medication. Most participants (75%, South Africa and Kenya) preferred a potential long-acting injectable over oral PrEP, most frequently for a longer duration of effectiveness in South Africa (87% South Africa, 42% Kenya) versus discretion in Kenya (5% South Africa, 49% Kenya). Eighty-seven percent of participants preferred oral PrEP over a potential long-acting vaginal ring, mostly due to concern about possible discomfort with vaginal insertion (82% South Africa, 48% Kenya). Significant predictors of long-acting PrEP preference included past use of injectable contraceptive (aOR = 2.48, 95% CI: 1.34, 4.57), disliking at least one oral PrEP attribute (aOR = 1.72, 95% CI: 1.05, 2.80) and preferring infrequent PrEP use (aOR = 1.58, 95% CI: 0.94, 2.65). CONCLUSIONS Oral PrEP-experienced pregnant and postpartum women expressed a theoretical preference for long-acting injectable PrEP over other modalities, demonstrating potential acceptability among a key population who must be at the forefront of injectable PrEP rollout. Reasons for PrEP preferences differed by country, emphasizing the importance of increasing context-specific options and choice of PrEP modalities for pregnant and postpartum women.
Collapse
Affiliation(s)
- Nafisa J Wara
- David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Rufaro Mvududu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mary M Marwa
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Laurén Gómez
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nyiko Mashele
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Corrina Moucheraud
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Risa Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Dvora L Joseph Davey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
15
|
Mazumder C, Dollah A, Ouda R, Okombo M, Nyakina J, Makia ML, Dettinger JC, Gómez L, Marwa M, Ochieng B, Abuna F, Gwayi-Chore C, Pintye J, Kinuthia J, John-Stewart G, Pfeiffer J, Mugambi ML. Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis. Front Reprod Health 2023; 5:1092001. [PMID: 37091549 PMCID: PMC10117977 DOI: 10.3389/frph.2023.1092001] [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: 11/07/2022] [Accepted: 03/06/2023] [Indexed: 04/09/2023] Open
Abstract
Background There are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in early pregnancy. Methods From April 2021 to July 2021, we interviewed women from four antenatal care clinics in Homa Bay and Siaya counties. We recruited women previously enrolled in the PrEP Implementation for Mothers in Antenatal care (PrIMA) study, a cluster-randomized trial that evaluated the best approaches to implementing PrEP in maternal and child health clinics in Western Kenya (NCT03070600). Interviews were conducted via phone, audio recorded, translated, and transcribed verbatim. We coded and analyzed the transcripts to capture factors influencing women's capability, opportunity, and motivation to use home pregnancy tests. Results We conducted 48 semistructured interviews with women aged 21-42 years. Twenty-seven women did not use a home pregnancy test in their most recent pregnancy. Seventeen of these women reported not using a home pregnancy test before. Lack of knowledge, mistrust in the accuracy of tests, preferring to rely on signs and symptoms of pregnancy or get a test from the health facility, cost, and accessibility were key barriers to home pregnancy test use. Conclusion Improving the uptake of home pregnancy testing during early pregnancy will require efforts to enhance community knowledge of test use and associated benefits and reduce cost burdens by making tests more affordable and accessible.
Collapse
Affiliation(s)
- Christina Mazumder
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Annabel Dollah
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Judith Nyakina
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Monica L. Makia
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Julia C. Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Laurén Gómez
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Mary Marwa
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Ben Ochieng
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Claire Gwayi-Chore
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- University of Nairobi, 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
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - James Pfeiffer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Melissa L. Mugambi
- Department of Global Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
16
|
Mogaka JN, Otieno FA, Akim E, Beima-Sofie K, Dettinger J, Gomez L, Marwa M, Odhiambo B, Ngure K, Ronen K, Sharma M, John-Stewart G, Richardson B, Stern J, Unger J, Udren J, Watoyi S, Pintye J, Kinuthia J. Correction: A Text Messaging-Based Support Intervention to Enhance Pre-exposure Prophylaxis for HIV Prevention Adherence During Pregnancy and Breastfeeding: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47124. [PMID: 36930878 PMCID: PMC10131893 DOI: 10.2196/47124] [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] [Received: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
[This corrects the article DOI: 10.2196/41170.].
Collapse
Affiliation(s)
| | | | | | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lauren Gomez
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Mary Marwa
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, WA, United States.,School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Barbra Richardson
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Joshua Stern
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jennifer Unger
- Department of Global Health, University of Washington, Seattle, WA, United States.,Women and Infants Hospital, Providence, RI, United States
| | - Jenna Udren
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Jillian Pintye
- School of Nursing, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Kenyatta National Hospital, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
17
|
Pintye J, Odoyo J, Nyerere B, Achieng P, Araka E, Omondi C, Ortblad KF, Mugambi ML, Baeten JM, Bukusi EA. Nurse-facilitated preexposure prophylaxis delivery for adolescent girls and young women seeking contraception at retail pharmacies in Kisumu, Kenya. AIDS 2023; 37:617-623. [PMID: 36653342 PMCID: PMC9974532 DOI: 10.1097/qad.0000000000003447] [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: 05/12/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We evaluated preexposure prophylaxis (PrEP) uptake, initiation, and continuation within a nurse-facilitated pharmacy-based delivery model for Kenyan adolescent girls and young women (AGYW) seeking contraception at retail pharmacies. METHODS From October 2020 to March 2021, PrEP-trained nurses were stationed at three retail pharmacies in Kisumu, Kenya. AGYW (aged 15-24 years) purchasing contraception (emergency contraception, oral contraceptive pills, injectables, implants, condoms) were counseled on PrEP, completed HIV testing, and offered a free 1-month supply of PrEP pills per national guidelines by nurses under supervision of a remote physician. We evaluated uptake among all AGYW offered PrEP. At 30 days after uptake, we evaluated PrEP use initiation and plans for continuation. RESULTS We enrolled 235 AGYW clients who were HIV-negative and purchasing contraception at pharmacies. Emergency contraception was the most frequently purchased contraceptive (35%). Median age was 22 years (IQR 19-23), 44% were currently in school, and 33% currently had multiple sexual partners. One-fourth (24%) exchanged sex for money or favors and 14% had sex while intoxicated in the prior 6 months. Overall, PrEP uptake was 85%; at 1 month, 82% had initiated PrEP use and 68% planned to continue use. Among those initiating PrEP, 69% were willing to pay for PrEP at retail pharmacies (median KES 150, IQR 100-200) even if available for free at public sector facilities. CONCLUSION In this evaluation of nurse-facilitated PrEP delivery at pharmacies in Kenya, a substantial proportion of AGYW who purchased contraception subsequently initiated PrEP, planned to continue use, and were willing to pay for PrEP.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jared M. Baeten
- University of Washington, Seattle, Washington, USA
- Gilead Sciences, Foster City, California, USA
| | - Elizabeth A. Bukusi
- University of Washington, Seattle, Washington, USA
- Kenya Medical Research Institute, Kisumu, Kenya
| |
Collapse
|
18
|
Larsen A, Pintye J, Odhiambo B, Mwongeli N, Marwa MM, Watoyi S, Kinuthia J, Abuna F, Gomez L, Dettinger J, Bhat A, John-Stewart G. Comparing depression screening tools (CESD-10, EPDS, PHQ-9, and PHQ-2) for diagnostic performance and epidemiologic associations among postpartum Kenyan women: Implications for research and practice. J Affect Disord 2023; 324:637-644. [PMID: 36586607 PMCID: PMC9990497 DOI: 10.1016/j.jad.2022.12.101] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 08/24/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Identifying optimal depression screening tools for use in maternal health clinics could improve maternal and infant health. We compared four tools for diagnostic performance and epidemiologic associations. METHODS This study was nested in a cluster-randomized trial in Kenya. Women in 20 maternal health clinics were evaluated at 6 weeks postpartum with Center for Epidemiologic Studies Depression Scale (CESD-10), Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 and -2 (PHQ-9, PHQ-2) for moderate-to-severe depressive symptoms (MSD) [CESD-10 ≥ 10, EPDS≥13, PHQ-9 ≥ 10, or PHQ-2 ≥ 3]. We assessed area under the curve (AUC) per scale (CESD-10, EPDS) against probable major depressive disorder (MDD) using the PHQ-9 scoring algorithm. Associations between MSD and intimate partner violence (IPV) were compared between scales. RESULTS Among 3605 women, median age was 24 and 10 % experienced IPV. Prevalence of MSD symptoms varied by tool: 13 % CESD-10, 9 % EPDS, 5 % PHQ-2, 3 % PHQ-9. Compared to probable MDD, the CESD-10 (AUC:0.82) had higher AUC than the EPDS (AUC:0.75). IPV was associated with MSD using all scales: EPDS (RR:2.5, 95%CI:1.7-3.7), PHQ-2 (RR:2.3, 95%CI:1.6-3.4), CESD-10 (RR:1.9, 95%CI:1.2-2.9), PHQ-9 (RR:1.8, 95%CI:0.8-3.8). LIMITATIONS Our study did not include clinical diagnosis of MDD by a specialized clinician, instead we used provisional diagnosis of probable MDD classified by the PHQ-9 algorithm as a reference standard in diagnostic performance evaluations. CONCLUSION Depression screening tools varied in detection of postpartum MSD. The PHQ-2 would prompt fewer referrals and showed strong epidemiologic association with a cofactor.
Collapse
Affiliation(s)
- Anna Larsen
- University of Washington, Department of Epidemiology, United States of America.
| | - Jillian Pintye
- University of Washington, Department of Global Health, United States of America
| | - Ben Odhiambo
- University of Nairobi/Kenyatta National Hospital, Kenya
| | | | - Mary M Marwa
- University of Nairobi/Kenyatta National Hospital, Kenya
| | | | - John Kinuthia
- University of Nairobi/Kenyatta National Hospital, Kenya
| | - Felix Abuna
- University of Nairobi/Kenyatta National Hospital, Kenya
| | - Laurén Gomez
- University of Washington, Department of Global Health, United States of America
| | - Julia Dettinger
- University of Washington, Department of Global Health, United States of America
| | - Amritha Bhat
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Grace John-Stewart
- University of Washington, Department of Epidemiology, United States of America; University of Washington, Department of Global Health, United States of America; University of Washington, Department of Medicine, United States of America; University of Washington, Department of Pediatrics, United States of America
| |
Collapse
|
19
|
Kiptinness C, Naik P, Thuo N, Malen RC, Dettinger JC, Pintye J, Rafferty M, Jomo E, Nyamasyo N, Wood T, Isabelli P, Morris S, Hattery D, Stergachis A, Were D, Sharma M, Ngure K, Mugambi ML, Ortblad KF. Online HIV prophylaxis delivery: Protocol for the ePrEP Kenya pilot study. Front Public Health 2023; 11:1054559. [PMID: 36908449 PMCID: PMC9998902 DOI: 10.3389/fpubh.2023.1054559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/31/2023] [Indexed: 03/14/2023] Open
Abstract
Background Online pharmacies in Kenya provide sexual and reproductive health products (e.g., HIV self-testing, contraception) and could be leveraged to increase the reach of HIV pre-exposure and post-exposure prophylaxis (PrEP/PEP) to populations who do not frequently attend health facilities. To date, evidence is limited for operationalizing online PrEP/PEP delivery and the type of populations reached with this differential service delivery model. Methods The ePrEP Kenya Pilot will deliver daily oral PrEP and PEP via MYDAWA, a private online pharmacy retailer, to clients in Nairobi for 18 months. Potential clients will obtain information about PrEP/PEP on MYDAWA's sexual wellness page and self-screen for HIV risk. Individuals ≥18 years, identified as at HIV risk, and willing to pay for a blood-based HIV self-test and PrEP/PEP delivery will be eligible for enrollment. To continue with online PrEP/PEP initiation, eligible clients will purchase a blood-based HIV self-test for 250 KES (~USD 2) [delivered to their setting of choice for 99 KES (~USD 1)], upload an image of their self-test result, and attend a telemedicine visit with a MYDAWA provider. During the telemedicine visit, providers will screen clients for PrEP/PEP eligibility, including clinical concerns (e.g., kidney disease), discuss self-test results, and complete counseling on PrEP/PEP use and safety. Providers will refer clients who self-test HIV positive or report any existing medical conditions to the appropriate services at healthcare facilities that meet their preferences. Eligible clients will be prescribed PrEP (30-day PrEP supply at initiation; 90-day PrEP supply at follow-up visits) or PEP (28-day supply) for free and have it delivered for 99 KES (~USD 1). We will measure PrEP and PEP initiation among eligible clients, PEP-to-PrEP transition, PrEP continuation, and implementation outcomes (e.g., feasibility, acceptability, and costs). Discussion Establishing pathways to increase PrEP and PEP access is crucial to help curb new HIV infections in settings with high HIV prevalence. The findings from this study will provide evidence on the implementation of online pharmacy PrEP and PEP service delivery that can help inform guidelines in Kenya and similar settings.
Collapse
Affiliation(s)
- Catherine Kiptinness
- Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Paulami Naik
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Nicholas Thuo
- Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel C. Malen
- Public Health Science Division, Fred Hutchinson Cancer Center, 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, Seattle, WA, United States
| | | | | | | | | | | | | | | | - Andy Stergachis
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Pharmacy, University of Washington, Seattle, WA, United States
| | | | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Katrina F. Ortblad
- Public Health Science Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| |
Collapse
|
20
|
Kinuthia J, Dettinger JC, Stern J, Ngumbau N, Ochieng B, Gómez L, Abuna F, Watoyi S, Marwa M, Odinga D, Wagner AD, Richardson BA, Pintye J, Baeten JM, John‐Stewart G. Risk-based versus universal PrEP delivery during pregnancy: a cluster randomized trial in Western Kenya from 2018 to 2019. J Int AIDS Soc 2023; 26:e26061. [PMID: 36807505 PMCID: PMC9939942 DOI: 10.1002/jia2.26061] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Integrating pre-exposure prophylaxis (PrEP) delivery for pregnant and postpartum women within maternal and child health (MCH) clinics is feasible and acceptable. It is unknown whether a risk-guided model would facilitate appropriate PrEP use among MCH attendees better than universally offering PrEP. METHODS The PrEP Implementation for Mothers in Antenatal Care (PrIMA) study was a cluster randomized trial to assess two models for PrEP delivery among pregnant women seeking routine MCH care at 20 public clinics in Kenya between January 2018 and July 2019 (NCT03070600). In the Universal arm, all participants received PrEP counselling and self-selected whether to initiate PrEP. In the Targeted arm, participants underwent an HIV risk assessment, including an objective risk-scoring tool and an offer of HIV self-tests for at-home partner testing; those determined to be at high risk received a PrEP offer. Participants were followed through 9 months postpartum. Primary outcomes included incident HIV and appropriate PrEP use (defined as PrEP uptake among those at high risk and no PrEP uptake for those not at risk). Outcomes were compared using intention-to-treat analyses, adjusting for baseline HIV risk and marital status. RESULTS Among 4447 women enrolled, the median age was 24.0 years (interquartile range [IQR]: 20.9, 28.3), and most were married (84.8%). The median gestational age at enrolment was 24 weeks (IQR: 20, 30). Women in the Targeted arm were more likely to be at high risk for HIV acquisition at baseline (51.6% vs. 33.3%). During 4638 person-years (p-yr) of follow-up, there were 16 maternal HIV infections with no difference in maternal HIV incidence between arms: 0.31/100 p-yr (95% CI: 0.15, 0.65) Targeted and 0.38/100p-yr (95% CI: 0.20, 0.73) Universal (adjusted relative risk [aRR]: 0.85 [CI: 0.28, 2.55]). There was no significant difference in the frequency of appropriate PrEP use between the arms (68.2% vs. 59.1% in Targeted vs. Universal, respectively) (aRR: 1.03 [CI: 0.96, 1.10]). CONCLUSIONS Given comparable maternal HIV incidence and PrEP uptake in Universal and Targeted approaches, and the simplicity that universal PrEP offers, our findings suggest that universal PrEP counselling is optimal for integrating PrEP in MCH systems.
Collapse
Affiliation(s)
- John Kinuthia
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | | | - Joshua Stern
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Nancy Ngumbau
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Ben Ochieng
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Laurén Gómez
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Felix Abuna
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Salphine Watoyi
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Mary Marwa
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Daniel Odinga
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Anjuli D. Wagner
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Barbra A. Richardson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA,Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWashingtonUSA,Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Jillian Pintye
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of Behavioral Nursing & Health InformaticsUniversity of WashingtonSeattleWashingtonUSA
| | - Jared M. Baeten
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA,Gilead SciencesFoster CityCaliforniaUSA
| | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA,Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| |
Collapse
|
21
|
Mogaka JN, Otieno FA, Akim E, Beima-Sofie K, Dettinger J, Gomez L, Marwa M, Odhiambo B, Ngure K, Ronen K, Sharma M, John-Stewart G, Richardson B, Stern J, Unger J, Udren J, Watoyi S, Pintye J, Kinuthia J. A Text Messaging-Based Support Intervention to Enhance Pre-exposure Prophylaxis for HIV Prevention Adherence During Pregnancy and Breastfeeding: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41170. [PMID: 36716092 PMCID: PMC9926344 DOI: 10.2196/41170] [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: 07/18/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. OBJECTIVE We are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women's and Children's Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. METHODS The mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. RESULTS Enrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. CONCLUSIONS This trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. TRIAL REGISTRATION ClinicalTrials.gov NCT04472884; https://clinicaltrials.gov/ct2/show/NCT04472884. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41170.
Collapse
Affiliation(s)
| | | | | | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lauren Gomez
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Mary Marwa
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, WA, United States
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Barbra Richardson
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Joshua Stern
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jennifer Unger
- Department of Global Health, University of Washington, Seattle, WA, United States
- Women and Infants Hospital, Providence, RI, United States
| | - Jenna Udren
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Jillian Pintye
- School of Nursing, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
22
|
Vera M, Bukusi E, Achieng P, Aketch H, Araka E, Baeten JM, Beima-Sofie K, John-Stewart G, Kohler PK, Mugambi ML, Nyerere B, Odoyo J, Omom C, Omondi C, Ortblad KF, Pintye J. "Pharmacies are Everywhere, and You can get it at any Time": Experiences With Pharmacy-Based PrEP Delivery Among Adolescent Girls and Young Women in Kisumu, Kenya. J Int Assoc Provid AIDS Care 2023; 22:23259582231215882. [PMID: 37997351 PMCID: PMC10676062 DOI: 10.1177/23259582231215882] [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: 06/03/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Many Kenyan adolescent girls and young women (AGYW) with behaviors associated with HIV acquisition access contraception at retail pharmacies. Offering oral pre-exposure prophylaxis (PrEP) in pharmacies could help reach AGYW with PrEP services. METHODS We piloted PrEP delivery at 3 retail pharmacies in Kisumu, Kenya. AGYW purchasing contraception were offered PrEP by nurses with remote prescriber oversight. AGYW who accepted were provided with a free 1-month supply. We conducted in-depth interviews with AGYW 30 days postobtaining PrEP. Transcripts were analyzed to explore experiences of AGYW accessing PrEP at pharmacies. RESULTS We conducted 41 interviews. AGYW preferred pharmacies for accessing PrEP and they were willing to pay for PrEP even if available for free at clinics. Reasons for this preference included accessibility, lack of queues, and medication stockouts, privacy, anonymity, autonomy, and high-quality counseling from our study nurses. CONCLUSIONS Pharmacies may be an important PrEP access option for this population.
Collapse
Affiliation(s)
- Melissa Vera
- School of Nursing and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Elizabeth Bukusi
- School of Nursing and Department of Global Health, University of Washington, Seattle, WA, USA
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | | | - Jared M. Baeten
- School of Nursing and Department of Global Health, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kristin Beima-Sofie
- School of Nursing and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- School of Nursing and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Pamela K. Kohler
- School of Nursing and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Melissa L. Mugambi
- School of Nursing and Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Jillian Pintye
- School of Nursing and Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
23
|
Kuo AP, Roche SD, Mugambi ML, Pintye J, Baeten JM, Bukusi E, Ngure K, Stergachis A, Ortblad KF. The effectiveness, feasibility and acceptability of HIV service delivery at private pharmacies in sub-Saharan Africa: a scoping review. J Int AIDS Soc 2022; 25:e26027. [PMID: 36285619 PMCID: PMC9597376 DOI: 10.1002/jia2.26027] [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: 04/18/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Private pharmacies are an understudied setting for differentiated delivery of HIV services that may address barriers to clinic-delivered services, such as stigma and long wait times. To understand the potential for pharmacy-delivered HIV services in sub-Saharan Africa, we conducted a scoping review of the published and grey literature. METHODS Using a modified Cochrane approach, we searched electronic databases through March 2022 and HIV conference abstracts in the past 5 years for studies that: (1) focused on the delivery of HIV testing, antiretroviral therapy (ART) and/or pre-exposure prophylaxis (PrEP) at private pharmacies in sub-Saharan Africa; (2) reported on effectiveness outcomes (e.g. HIV incidence) or implementation outcomes, specifically feasibility and/or acceptability; and (3) were published in English. Two authors identified studies and extracted data on study setting, population, design, outcomes and findings by HIV service type. RESULTS AND DISCUSSION Our search identified 1646 studies. After screening and review, we included 28 studies: seven on HIV testing, nine on ART delivery and 12 on PrEP delivery. Most studies (n = 16) were conducted in East Africa, primarily in Kenya. Only two studies evaluated effectiveness outcomes; the majority (n = 26) reported on feasibility and/or acceptability outcomes. The limited effectiveness data (n = 2 randomized trials) suggest that pharmacy-delivered HIV services can increase demand and result in comparable clinical outcomes (e.g. viral load suppression) to standard-of-care clinic-based models. Studies assessing implementation outcomes found actual and hypothetical models of pharmacy-delivered HIV services to be largely feasible (e.g. high initiation and continuation) and acceptable (e.g. preferable to facility-based models and high willingness to pay/provide) among stakeholders, providers and clients. Potential barriers to implementation included a lack of pharmacy provider training on HIV service delivery, costs to clients and providers, and perceived low quality of care. CONCLUSIONS The current evidence suggests that pharmacy-delivered HIV services may be feasible to implement and acceptable to clients and providers in parts of sub-Saharan Africa. However, limited evidence outside East Africa exists, as does limited evidence on the effectiveness of and costs associated with pharmacy-delivered HIV services. More research of this nature is needed to inform the scale-up of this new differentiated service delivery model throughout the region.
Collapse
Affiliation(s)
- Alexandra P. Kuo
- Department of PharmacyUniversity of WashingtonSeattleWashingtonUSA
| | - Stephanie D. Roche
- Public Health Sciences DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | | | - Jillian Pintye
- School of NursingUniversity of WashingtonSeattleWashingtonUSA
| | - Jared M. Baeten
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- School of NursingUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Gilead SciencesFoster CityCaliforniaUSA
| | - Elizabeth Bukusi
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWashingtonUSA
| | - Kenneth Ngure
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Community HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | - Andy Stergachis
- Department of PharmacyUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Katrina F. Ortblad
- Public Health Sciences DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| |
Collapse
|
24
|
Mugambi ML, Pintye J, Heffron R, Barnabas RV, John-Stewart G. HIV Prevention Tools Across the Pregnancy Continuum: What Works, What Does Not, and What Can We Do Differently? Curr HIV/AIDS Rep 2022; 19:293-300. [PMID: 35984551 PMCID: PMC9717592 DOI: 10.1007/s11904-022-00621-1] [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] [Accepted: 07/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Multiple tools exist to support the primary prevention of HIV in pregnant and postpartum women; however, there are opportunities to enhance their use and impact. This review summarizes the current status of HIV prevention tools and existing gaps and opportunities to improve their use along the pregnancy care continuum. RECENT FINDINGS HIV screening efforts have steadily improved with close to universal screening of pregnant women in several East and Southern African countries. Strategies to implement partner testing through the distribution of HIV self-test kits are promising though linkage to care remains challenging. Syphilis screening rates are increasing though detection of other sexually transmitted infections could benefit from improved diagnostic capacity. Male and female condoms are rarely used and are often not the optimal tool of choice during pregnancy. Oral pre-exposure prophylaxis (PrEP) is a promising tool, although barriers such as the need for daily adherence, side effects, and stigma may limit its use. There is a growing pipeline of PrEP agents with alternative delivery platforms that might suit women's preferences better and supports the notion that choice is vital to improving HIV prevention coverage during the pregnancy-postpartum continuum. Clear guidance on which tools to use and how to use them, safety data supporting their use, and surveillance data documenting the scale and effectiveness of the tools will be imperative in establishing a path to more impactful prevention efforts among pregnant and postpartum women.
Collapse
Affiliation(s)
- Melissa Latigo Mugambi
- Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA.
| | - Jillian Pintye
- Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Renee Heffron
- Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- University of Alabama Birmingham, Birmingham, AB, USA
| | - Ruanne Vanessa Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Grace John-Stewart
- Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
25
|
Larsen A, Pintye J, Marwa MM, Watoyi S, Kinuthia J, Abuna F, Richardson BA, Gomez L, Dettinger JC, John-Stewart G. Trajectories and predictors of perinatal depressive symptoms among Kenyan women: a prospective cohort study. Lancet Psychiatry 2022; 9:555-564. [PMID: 35598606 PMCID: PMC9233088 DOI: 10.1016/s2215-0366(22)00110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 03/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND There are gaps in understanding longitudinal patterns and predictors of perinatal depressive symptoms in sub-Saharan Africa. This study aimed to explore trajectories of depressive symptoms and associated factors from pregnancy to 9 months post partum among Kenyan women. METHODS In this prospective cohort study, we analysed data from the PrEP Implementation for Mothers in Antenatal Care (PrIMA) study in which HIV-negative women were enrolled in pregnancy and followed up to 9 months post partum in 20 public sector maternal-child health clinics in western Kenya. Pregnant women were eligible for enrolment if they were not infected with HIV, aged 15 years or older, and were able to provide consent. Eligible participants were screened and enrolled between Jan 15, 2018, and July 31, 2019, and followed up to 9 months post partum, with the last participant study visit conducted on Jan 15, 2021. Study nurses serially assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence with the Hurt, Insult, Threaten, Scream scale, and social support with the Medical Outcomes Study scale. Generalised estimating equations were used to identify correlates of moderate-to-severe depressive symptoms (CESD-10 score ≥10) and group-based trajectory modelling identified discrete trajectories of perinatal depressive symptoms. FINDINGS Among 4447 participants in the main PrIMA study, 3555 had complete depressive symptom data in pregnancy and depressive symptom data post partum and were included in the primary analysis. Median age was 24·0 years (IQR 21·0-28·7), 1330 (38%) participants had low social support, and 278 (8%) reported intimate partner violence in pregnancy. All participants (100%) were female and all (100%) were of African Kenyan ethnicity. Prevalence of moderate-to-severe depressive symptoms was higher in pregnancy than post partum (870 [24·5%; 95% CI 23·1-25·9] vs 597 [6·8%; 15·6-18·1]; p<0·0001). Five patterns of depressive symptoms were identified; persistent moderate-to-severe depressive symptoms in pregnancy and post partum (295 [8·3%]), moderate-to-severe depressive symptoms in pregnancy that resolved post partum (139 [3·9%]), moderate-to-severe depressive symptoms that emerged post partum (40 [1·1%]), chronically mild symptoms (2709 [76·2%]), and no depressive symptoms (372 [10·5%]). Emergent moderate-to-severe depressive symptoms were associated with older age. Emergent, persistent, and resolving moderate-to-severe depressive symptoms were associated with intimate partner violence during pregnancy; and persistent and resolving moderate-to-severe depressive symptoms were associated with low social support and high HIV risk (all p<0·05). Moderate-to-severe depressive symptom risk was significantly increased with intimate partner violence (adjusted odds ratio 2·07 [95% CI 1·81-2·31]; p<0·0001), low social support (1·74 [1·56-1·95]; p<0·0001), and partner HIV-positive status (1·48 [1·22-1·78]; p<0·0001). 23·34% (95% CI 18·77-27·65) of cases of perinatal moderate-to-severe depressive symptoms were attributable to low social support. INTERPRETATION One third of women had perinatal moderate-to-severe depressive symptoms; nearly half of these had higher severity phenotypes of resolving, persistent, and emerging moderate-to-severe depressive symptoms that might require tailored interventions. Perinatal women with comorbid psychosocial stressors such as intimate partner violence and previous pregnancy loss should be prioritised for mental health services that augment social support within routine maternal-child health care. FUNDING National Institutes of Health. TRANSLATION For the Kiswahili translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Mary M Marwa
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Salphine Watoyi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Laurén Gomez
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| |
Collapse
|
26
|
Lim S, Pintye J, Seong H, Bekemeier B. Estimating the Association Between Public Health Spending and Sexually Transmitted Disease Rates in the United States: A Systematic Review. Sex Transm Dis 2022; 49:462-468. [PMID: 35312659 DOI: 10.1097/olq.0000000000001627] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Public health spending is important for managing increases in sexually transmitted diseases (STDs) in the United States. Although previous studies suggest that a beneficial link exists between public health spending and changes in STD rates, there have been no systematic reviews synthesizing existing evidence regarding the association for STDs at the population level. The objective of this study was to synthesize evidence from studies that assessed the associations between general and STD-specific public health spending and STD rates. We conducted a systematic review using Ovid-Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, and EconLit for relevant studies that examined the association between public health spending and gonorrhea, syphilis, chlamydia, and chancroid rates following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 5 articles (2 regarding general public health spending and 3 regarding STD-specific public health spending) met our inclusion criteria. There was a significant decrease in gonorrhea, syphilis, chlamydia, and chancroid rates associated with increased public health spending. We also found that STD-specific public health spending has a greater effect on STD rates compared with general public health spending. Our review provides evidence that increases in general and STD-specific public health spending are associated with a reduction of STD rates. Such research regarding estimates of the impact of STD prevention spending can help policy makers identify priority funding areas and inform health resource allocation decisions.
Collapse
Affiliation(s)
- Sungwon Lim
- From the Departments of Child, Family, and Population Health
| | - Jillian Pintye
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA
| | - Hohyun Seong
- School of Nursing, University of Maryland, Baltimore, MD
| | - Betty Bekemeier
- From the Departments of Child, Family, and Population Health
| |
Collapse
|
27
|
Kangethe JM, Monroe-Wise A, Muiruri PN, Komu JG, Mutai KK, Nzivo MM, Pintye J. Utilisation of cervical cancer screening among women living with HIV at Kenya’s national referral hospital. South Afr J HIV Med 2022; 23:1353. [PMID: 35706549 PMCID: PMC9082290 DOI: 10.4102/sajhivmed.v23i1.1353] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA) and Pap smear cytology. Objectives We evaluated utilisation of cervical cancer screening and human papillomavirus (HPV) vaccination among women living with HIV (WLHIV) receiving HIV care at KNH. Method From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services. We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers. Results Overall, 305 WLHIV participated in the survey. Median age was 36 years (interquartile range [IQR]: 28–43), 41% were married, and 38% completed secondary education. Most (90%) had HIV RNA < 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination. Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P < 0.05). In FGDs, barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times. Conclusion Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers contributed to low utilisation.
Collapse
Affiliation(s)
- James M Kangethe
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
- Department of Global Health, International AIDS Research and Training Program, University of Washington, Seattle, United States of America
| | - Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Peter N Muiruri
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - James G Komu
- Department of Medical Laboratory Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Kenneth K Mutai
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - Mirriam M Nzivo
- Department of Biological Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Biological Sciences, University of Embu, Embu, Kenya
| | - Jillian Pintye
- Department of Global Health, International AIDS Research and Training Program, University of Washington, Seattle, United States of America
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, United States of America
| |
Collapse
|
28
|
Ortblad KF, Mawandia S, Bakae O, Tau L, Grande M, Mogomotsi GP, Mmatli E, Ngombo M, Seckel L, Heffron R, Pintye J, Ledikwe J. Using routine programmatic data to measure HIV incidence among pregnant women in Botswana. Popul Health Metr 2022; 20:10. [PMID: 35246143 PMCID: PMC8896233 DOI: 10.1186/s12963-022-00287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pregnant women in sub-Saharan Africa have high risk of HIV acquisition, yet approaches for measuring maternal HIV incidence using routine surveillance systems are undefined. We used programmatic data from routine antenatal care (ANC) HIV testing in Botswana to measure real-world HIV incidence during pregnancy. METHODS From January 2018 to September 2019, the Botswana Ministry of Health and Wellness implemented an HIV testing program at 139 ANC clinics. The program captured information on testers' age, testing date and result, and antiretroviral treatment (ART) initiation. In our analysis, we excluded individuals who previously tested HIV-positive prior to their first ANC visit. We defined incident HIV infection as testing HIV-positive at an ANC visit after a prior HIV-negative result within ANC. RESULTS Overall, 29,570 pregnant women (median age 26 years, IQR 22-31) tested for HIV at ANC clinics: 3% (836) tested HIV-positive at their first recorded ANC visit and 97% tested HIV-negative (28,734). Of those who tested HIV-negative, 28% (7940/28,734) had a repeat HIV test recorded at ANC. The median time to HIV re-testing was 92 days (IQR 70-112). In total, 17 previously undiagnosed HIV infections were detected (HIV incidence 8 per 1000 person-years, 95% CI 0.5-1.3). ART initiation among women newly diagnosed with HIV at ANC (853) was 88% (671/762). CONCLUSIONS In Botswana, real-world HIV incidence among pregnant women at ANC remains above levels of HIV epidemic control (≤ 1 per 1000 person-years). This study shows how HIV programmatic data can answer timely population-level epidemiological questions and inform ongoing implementation of HIV prevention and treatment programs.
Collapse
Affiliation(s)
- Katrina F Ortblad
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | - Shreshth Mawandia
- Department of Global Health, University of Washington, Seattle, USA.,International Training and Education Center for Health, Gaborone, Botswana
| | - Odirile Bakae
- International Training and Education Center for Health, Gaborone, Botswana
| | - Lenna Tau
- International Training and Education Center for Health, Gaborone, Botswana
| | - Matias Grande
- International Training and Education Center for Health, Gaborone, Botswana
| | | | | | | | - Laura Seckel
- Department of Global Health, University of Washington, Seattle, USA.,International Training and Education Center for Health, Seattle, USA
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA
| | - Jillian Pintye
- School of Nursing, University of Washington, Seattle, USA
| | - Jenny Ledikwe
- Department of Global Health, University of Washington, Seattle, USA.,International Training and Education Center for Health, Gaborone, Botswana
| |
Collapse
|
29
|
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.
Collapse
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
| | | |
Collapse
|
30
|
Larsen A, Abuna F, Owiti G, Kemunto V, Sila J, Wilson KS, Owens T, Pintye J, Richardson BA, Kinuthia J, John-Stewart G, Kohler P. Improving Quality of PrEP Counseling for Adolescent Girls and Young Women in Kenya With Standardized Patient Actors: A Dose-Response Analysis. J Acquir Immune Defic Syndr 2022; 89:34-39. [PMID: 34560769 PMCID: PMC8665073 DOI: 10.1097/qai.0000000000002814] [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: 05/19/2021] [Accepted: 08/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Health care worker (HCW) training using standardized patient actors (SPs) is an evidence-based approach for improving patient-provider interactions. We evaluated whether SP training among HCWs in Western Kenya improved the quality of pre-exposure prophylaxis (PrEP) counseling for adolescent girls and young women (AGYW). METHODS We conducted a 2-day SP training intervention among HCWs providing PrEP counseling for AGYW. Six trained SPs role played one encounter each with HCWs following scripts depicting common PrEP-seeking scenarios. SPs used checklists to report and discuss domains of adherence to national PrEP guidelines, communication, and interpersonal skills using validated scales after each encounter. HCWs presented to each case in a random order. Overall and domain-specific mean score percentages were compared between the first and subsequent case encounters using generalized linear models, clustering by HCWs. RESULTS During 564 training cases among 94 HCWs, the overall mean quality of PrEP counseling score was 83.1 (SD: 10.1); scores improved over the course of the 6 encounters (P < 0.001). Compared with the first case encounter, the mean scores for the fourth were significantly higher (79.1 vs. 85.9, P < 0.001). The mean scores plateaued from the fourth to the sixth case (85.2). Although HCWs demonstrated high baseline communication (95.3) and interpersonal skills (83.7), adherence to PrEP guidelines at baseline was suboptimal (57.6). By the fourth case, scores increased significantly (P < 0.001) for all domains. CONCLUSIONS SP training improved PrEP counseling overall and in domains of interpersonal skills, use of guidelines, and communication with AGYW and could be useful in efforts to improve the quality of PrEP counseling for AGYW.
Collapse
Affiliation(s)
- Anna Larsen
- Departments of Global Health
- Epidemiology, University of Washington, Seattle, WA
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - George Owiti
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Valarie Kemunto
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Kate S Wilson
- Policy Development & Evaluation Unit, Public Health Seattle/King County, Seattle, WA
| | - Tamara Owens
- Clinical Skills & Simulation Centers, Howard University, Washington, DC
| | - Jillian Pintye
- Departments of Global Health
- Departments of Biobehavioral Nursing and Health Informatics
| | | | - John Kinuthia
- Departments of Global Health
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health
- Epidemiology, University of Washington, Seattle, WA
- Medicine
- Pediatrics; and
| | - Pamela Kohler
- Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
| |
Collapse
|
31
|
Joseph Davey DL, Bekker LG, Bukusi EA, Chi BH, Delany-Moretlwe S, Goga A, Lyerly AD, Mgodi NM, Mugo N, Myer L, Noguchi LM, Stranix-Chibanda L, Slack C, Pintye J. Where are the pregnant and breastfeeding women in new pre-exposure prophylaxis trials? The imperative to overcome the evidence gap. The Lancet HIV 2022; 9:e214-e222. [DOI: 10.1016/s2352-3018(21)00280-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
|
32
|
Mwongeli N, Wagner AD, Dettinger JC, Pintye J, Brown Trinidad S, Awuor M, Kimemia G, Ngure K, Heffron RA, Baeten JM, Mugo N, Bukusi EA, Kinuthia J, Kelley MC, John-Stewart GC, Beima-Sofie KM. " PrEP Gives the Woman the Control": Healthcare Worker Perspectives on Using pre-Exposure Prophylaxis (PrEP) During Pregnancy and Postpartum in Kenya. J Int Assoc Provid AIDS Care 2022; 21:23259582221111068. [PMID: 35776525 PMCID: PMC9251967 DOI: 10.1177/23259582221111068] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Pregnant and postpartum women in high HIV prevalent regions are at increased HIV risk. Oral pre-exposure prophylaxis (PrEP) can decrease HIV incidence reducing infant HIV infections. Understanding healthcare worker (HCW) beliefs about PrEP prior to national roll-out is critical to supporting PrEP scale-up. Methods: We conducted 45 semi-structured interviews among a range of HCW cadres with and without PrEP provision experience purposively recruited from four clinics in Kenya to compare their views on prescribing PrEP during pregnancy and postpartum. Interviews were analysed using a conventional content analysis approach to identify key influences on PrEP acceptability and feasibility. Results: All HCWs perceived PrEP as an acceptable and feasible HIV prevention strategy for pregnant and postpartum women. They believed PrEP meets women’s needs as an on-demand, female-controlled prevention strategy that empowers women to take control of their HIV risk. HCWs highlighted their role in PrEP delivery success while acknowledging how their knowledge gaps, concerns and perceived PrEP implementation challenges may hinder optimal PrEP delivery. Conclusion: HCWs supported PrEP provision to pregnant and postpartum women. However, counseling tools to address risk perceptions in this population and strategies to reduce HCW knowledge gaps, concerns and perceived implementation barriers are required.
Collapse
Affiliation(s)
| | - Anjuli D Wagner
- Department of Global Health, 7284University of Washington, Seattle, WA, USA
| | - Julia C Dettinger
- Department of Global Health, 7284University of Washington, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,School of Nursing, 7284University of Washington, Seattle, WA, USA
| | - Susan Brown Trinidad
- Department of Bioethics and Humanities, 7284University of Washington, Seattle, WA, USA
| | - Merceline Awuor
- 7284University of Washington Kenya (UW-Kenya), Nairobi, Kenya
| | - Grace Kimemia
- Population Dynamic and Reproductive Health, 107883African Population and Health Research Center, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,Department of Community Health, 118985Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Renee A Heffron
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,Department of Epidemiology, 7284University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,Department of Epidemiology, 7284University of Washington, Seattle, WA, USA.,Department of Medicine, 7284University of Washington, Seattle, WA, USA.,2158Gilead Sciences, Foster City, USA
| | - Nelly Mugo
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,Partners in Health Research and Development, Thika, Kenya.,185955Centre for Clinical Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Elizabeth A Bukusi
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,185955Centre for Clinical Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Department of Obstetrics and Gynecology, 7284University of Washington, Seattle, WA, USA
| | - John Kinuthia
- 285569Kenyatta National Hospital, Nairobi, Kenya.,Department of Global Health, 7284University of Washington, Seattle, WA, USA
| | - Maureen C Kelley
- The Ethox Centre and 575097Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Grace C John-Stewart
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,Department of Epidemiology, 7284University of Washington, Seattle, WA, USA.,Department of Medicine, 7284University of Washington, Seattle, WA, USA.,Department of Pediatrics, 7284University of Washington, Seattle, WA, USA
| | | |
Collapse
|
33
|
Dettinger JC, Pintye J, Dollah A, Awuor M, Abuna F, Lagat H, Kohler P, John-Stewart G, O'Malley G, Kinuthia J, Beima-Sofie K. Brief Report: "What Is This PrEP?"-Sources and Accuracy of HIV Pre-Exposure Prophylaxis (PrEP) Awareness Among Adolescent Girls and Young Women Attending Family Planning and Maternal Child Health Clinics in Western Kenya. J Acquir Immune Defic Syndr 2021; 88:356-360. [PMID: 34379606 PMCID: PMC8556238 DOI: 10.1097/qai.0000000000002782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) delivery to adolescent girls and young women (AGYW) is scaling up in sub-Saharan African countries. Understanding how AGYW learn about PrEP is needed to inform programs seeking to reach AGYW with HIV prevention tools. METHODS AGYW (ages 15-24), attending routine family planning and maternal child health clinics in Kisumu, Kenya, participated in in-depth interviews. AGYW were recruited if they either declined or accepted PrEP when offered that day in clinic or were currently or previously on PrEP. Thematic analysis was used to identify key themes related to the type and quality of knowledge sources from which AGYW first became aware of PrEP. RESULTS Overall, 140 in-depth interviews were conducted with AGYW. The median age was 21.5 years (interquartile range: 20.0-23.0), 65% of participants were married, and almost half (45.7%) were currently taking PrEP. Participants reported learning about PrEP from 3 primary sources: (1) clinic-based education; (2) friends, family, or other PrEP users; and (3) media and community outreach. Participants who reported learning about PrEP from friends or family were highly enthusiastic about PrEP. The accuracy and completeness of knowledge varied with most inaccuracies around the cost, dosing, and who benefits from PrEP. Community outreach campaigns provided fewer details, resulting in more inaccurate information and distrust of information received. CONCLUSION PrEP information reaches AGYW through many sources with variable accuracy and completeness. Training providers and peer leaders to disseminate thorough and accurate PrEP information when counseling AGYW could positively impact acceptance and proper use.
Collapse
Affiliation(s)
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
| | | | - Mercy Awuor
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA
- University of Washington, Child, Family, and Population Health, Seattle, WA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA; and
- Department of Medicine, University of Washington, Seattle, WA
| | | | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA
- Kenyatta National Hospital, Nairobi, Kenya
| | | |
Collapse
|
34
|
Stalter RM, Pintye J, Mugwanya KK. Safety review of tenofovir disoproxil fumarate/emtricitabine pre-exposure prophylaxis for pregnant women at risk of HIV infection. Expert Opin Drug Saf 2021; 20:1367-1373. [PMID: 33998936 PMCID: PMC9010110 DOI: 10.1080/14740338.2021.1931680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/17/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023]
Abstract
Introduction: Pregnancy is a period of elevated HIV risk in high-burden settings, motivating the need for prevention tools that are both safe for use and effective during pregnancy. Oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) is recommended by the World Health Organization, including for pregnant and postpartum women at substantial risk of HIV infection. Although TDF use during pregnancy appears generally safe, data on PrEP use during pregnancy remain limited.Areas covered: We provide an overview of the clinical pharmacology and efficacy of daily TDF-based PrEP and summarize current evidence on the safety of PrEP use by pregnant HIV-uninfected women. We synthesize relevant studies assessing pregnancy outcomes among pregnant women who are living with HIV (WLHIV) and using TDF-based therapy. Finally, we make comparison to the safety profiles of other emerging HIV prevention options.Expert opinion: The current evidence indicates that TDF/FTC PrEP use is not associated with increased risk of adverse pregnancy and early infant growth outcomes. While safety data are generally reassuring, there is need for continued accrual of data on growth and pregnancy outcomes in PrEP research, implementation projects, and controlled pharmacokinetic studies to support current evidence and to understand concentration-efficacy relationship in pregnant women.
Collapse
Affiliation(s)
- Randy M. Stalter
- Epidemiology Department, University of Washington, Seattle, WA, USA
| | - Jillian Pintye
- School of Nursing, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
35
|
Dev R, Kohler P, Begnel E, Achwoka D, McGrath CJ, Pintye J, Muthigani W, Singa B, Gondi J, Ng'ang'a L, Langat A, John-Stewart G, Kinuthia J, Drake AL. Contraceptive counseling experiences among women attending HIV care and treatment centers: A national survey in Kenya. Contraception 2021; 104:139-146. [PMID: 33894251 PMCID: PMC8286320 DOI: 10.1016/j.contraception.2021.04.011] [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: 08/27/2020] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To characterize contraceptive counseling experiences among women living with HIV (WLWH) receiving HIV care in Kenya. STUDY DESIGN Sexually active, WLWH aged 15 to 49 years were purposively sampled from 109 high-volume HIV Care and Treatment Centers in Kenya between June and September 2016. Cross-sectional surveys were administered to enroll women on a tablet using Open Data Kit. Poisson generalized linear regression models adjusted for facility-level clustering were used to examine cofactors for receiving family planning (FP) counseling with a provider. RESULTS Overall, 4805 WLWH were enrolled, 60% reported they received FP counseling during the last year, 72% of whom reported they were counseled about benefits of birth spacing and limiting. Most women who received FP counseling were married (64%) and discussed FP with their partner (78%). Use of FP in the last month (adjusted Prevalence Ratio [aPR] = 1.74, 95% confidence interval [CI]: 1.41-2.15, p < 0.001), desire for children in >2 years (aPR = 1.18, 95% CI: 1.09-1.28, p < 0.001), and concern about contraceptive side-effects (aPR = 1.13, 95% CI 1.02-1.25, p < 0.05) were significantly higher among WLWH who received FP counseling compared to those that did not. CONCLUSIONS Over one-third of WLWH did not receiving FP counseling with an HIV care provider during the last year, and counseling was more commonly reported among women who were using FP or desired children in >2 years. IMPLICATIONS There are missed opportunities for FP counseling in HIV care. FP integration in HIV care could improve FP access and birth spacing or limiting among WLWH.
Collapse
Affiliation(s)
- Rubee Dev
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Pamela Kohler
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Emily Begnel
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Dunstan Achwoka
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Christine J McGrath
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Jillian Pintye
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Wangui Muthigani
- Reproductive and Maternal Health Service Unit, Ministry of Health, Nairobi, Kenya
| | - Benson Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Joel Gondi
- Reproductive and Maternal Health Service Unit, Ministry of Health, Nairobi, Kenya
| | - Lucy Ng'ang'a
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Agnes Langat
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Grace John-Stewart
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States; Department of Epidemiology, University of Washington, Seattle, WA, United States; Department of Pediatrics, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Department of Research and Programs, Kenyatta Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States.
| |
Collapse
|
36
|
Nyaboe E, Larsen A, Sila J, Kinuthia J, Owiti G, Abuna F, Kohler P, John-Stewart G, Pintye J. Contraceptive Method Mix and HIV Risk Behaviors Among Kenyan Adolescent Girls and Young Women Seeking Family Planning Services: Implications for Integrating HIV Prevention. Front Reprod Health 2021; 3:667413. [PMID: 36304017 PMCID: PMC9580727 DOI: 10.3389/frph.2021.667413] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding HIV risk behaviors among adolescent girls and young women (AGYW) seeking contraception could help inform integrating HIV prevention services within family planning (FP) clinics. Methods: From 10/2018 to 04/2019, we conducted a survey at 4 FP clinics in Kisumu, Kenya to evaluate risk behaviors among AGYW without HIV infection seeking contraception. All AGYW aged 15-24 were invited to participate following receipt of FP services. Adolescent girls and young women initiating or refilling contraception were included in this analysis. Long-acting reversible contraceptives (LARC) included intrauterine devices, implants, or injectables. Non-LARC methods included oral contraceptive pills (OCP) or condoms. We used an empiric risk score to assess HIV risk behaviors; HIV risk scores of ≥5 (corresponding to 5-15% HIV incidence) defined "high" HIV risk. Results: Overall, 555 AGYW seeking FP were included. Median age was 22 years [interquartile range (IQR) 20-23], median completed education was 12 years (IQR 10-12); 23% of AGYW had HIV risk scores of ≥5. The most frequent form of contraception was injectables (43%), followed by implants (39%). After adjustment for education, prior pregnancy, and marital status, LARC users more frequently engaged in transactional sex than non-LARC users [6 vs. 0%, adjusted prevalence ratio (PR) = 1.17, 95% CI 1.09-1.29, p < 0.001]; LARC use was not associated with HIV risk scores ≥5. Among LARC users, AGYW using injectables more frequently had condomless sex compared to AGYW using other LARC methods (85 vs. 75%, adjusted PR = 1.52, 95% CI 1.09-2.10, p = 0.012); injectable use was not associated with HIV risk scores ≥5. Conclusions: Adolescent girls and young women seeking contraception frequently had high HIV risk, emphasizing the importance of integrating HIV prevention within FP. Multipurpose technologies for contraception and HIV prevention could particularly benefit AGYW.
Collapse
Affiliation(s)
| | - Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - George Owiti
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Child, Family, and Population Health, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| |
Collapse
|
37
|
Pintye J, Ortblad KF, Mawandia S, Bakae O, Tau L, Grande M, Mogomotsi GP, Mmatli E, Ngombo M, Norman T, Seckel L, Ledikwe J. Frequent Detection of Undiagnosed HIV Within Emergency Departments in Botswana. Sex Transm Dis 2021; 48:e97-e100. [PMID: 33009278 DOI: 10.1097/olq.0000000000001312] [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] [Indexed: 11/27/2022]
Abstract
ABSTRACT Among 130,161 HIV testing records from unique individuals at 149 programmatic sites in Botswana, frequency of detecting undiagnosed HIV infection within emergency departments (EDs) was 4.7% (455/9695), 2-fold higher than other clinic-based HIV counseling and testing. Men and noncitizens less frequently initiated same-day antiretroviral therapy after testing HIV positive within emergency departments.
Collapse
Affiliation(s)
| | | | | | - Odirile Bakae
- International Training and Education Center for Health
| | - Lenna Tau
- International Training and Education Center for Health
| | - Matias Grande
- International Training and Education Center for Health
| | | | | | | | | | | | | |
Collapse
|
38
|
Ngure K, Trinidad SB, Beima-Sofie K, Kinuthia J, Matemo D, Kimemia G, Njoroge A, Achiro L, Pintye J, Mugo NR, Bukusi EA, Baeten JM, Heffron R, John-Stewart G, Kelley MC. Perceived Social Influences on Women's Decisions to use Medications not Studied in Pregnancy. A Qualitative Ethical Analysis of Preexposure Prophylaxis Implementation Research in Kenya. J Empir Res Hum Res Ethics 2021; 16:225-237. [PMID: 34133231 PMCID: PMC8261769 DOI: 10.1177/15562646211012296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Implementation research ethics can be particularly challenging when pregnant women have been excluded from earlier clinical stages of research given greater uncertainty about safety and efficacy in pregnancy. The evaluation of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) during pregnancy offered an opportunity to understand important ethical considerations and social influences shaping women's decisions to participate in the evaluation of PrEP and investigational drugs during pregnancy. We conducted interviews with women (n = 51), focus groups with male partners (five focus group discussions [FGDs]), interviews with health providers (n = 45), four FGDs with pregnant/postpartum adolescents and four FGDs with young women. Data were analyzed using thematic content analysis, including ethical aspects of the data. Our study reveals that women navigate a complex network of social influences, expectations, support, and gender roles, not only with male partners, but also with clinicians, family, and friends when making decisions about PrEP or other drugs that lack complete safety data during pregnancy.
Collapse
Affiliation(s)
- Kenneth Ngure
- Department of Community Health, 118985Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan B Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | | | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Research and Programs, 285569Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Matemo
- Department of Research and Programs, 285569Kenyatta National Hospital, Nairobi, Kenya
| | - Grace Kimemia
- Population Dynamic and Reproductive Health, 107883African Population and Health Research Center, Nairobi, Kenya
| | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Research and Programs, 285569Kenyatta National Hospital, Nairobi, Kenya
| | - Lillian Achiro
- Center for Microbiology Research, 118982Kenya Medical Research Institute Nairobi, Kenya
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Clinical Research, Kenya Medical Research Institute Nairobi, Kenya
| | - Elizabeth A Bukusi
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Microbiology Research, 118982Kenya Medical Research Institute Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Maureen C Kelley
- Wellcome Centre for Ethics & Humanities and Ethox Centre, Nuffield Department of Population Health, 6396University of Oxford, Oxford, UK
| |
Collapse
|
39
|
O'Malley G, Beima-Sofie KM, Roche SD, Rousseau E, Travill D, Omollo V, Delany-Moretlwe S, Bekker LG, Bukusi EA, Kinuthia J, Barnabee G, Dettinger JC, Wagner AD, Pintye J, Morton JF, Johnson RE, Baeten JM, John-Stewart G, Celum CL. Health Care Providers as Agents of Change: Integrating PrEP With Other Sexual and Reproductive Health Services for Adolescent Girls and Young Women. Front Reprod Health 2021; 3:668672. [PMID: 36303982 PMCID: PMC9580786 DOI: 10.3389/frph.2021.668672] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 10/07/2023] Open
Abstract
Background: Successful integration of pre-exposure prophylaxis (PrEP) with existing reproductive health services will require iterative learning and adaptation. The interaction between the problem-solving required to implement new interventions and health worker motivation has been well-described in the public health literature. This study describes structural and motivational challenges faced by health care providers delivering PrEP to adolescent girls and young women (AGYW) alongside other SRH services, and the strategies used to overcome them. Methods: We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with HCWs from two demonstration projects delivering PrEP to AGYW alongside other SRH services. The Prevention Options for the Women Evaluation Research (POWER) is an open label PrEP study with a focus on learning about PrEP delivery in Kenyan and South African family planning, youth mobile services, and public clinics at six facilities. PrIYA focused on PrEP delivery to AGYW via maternal and child health (MCH) and family planning (FP) clinics in Kenya across 37 facilities. IDIs and FGDs were transcribed verbatim and analyzed using a combination of inductive and deductive methods. Results: We conducted IDIs with 36 participants and 8 FGDs with 50 participants. HCW described a dynamic process of operationalizing PrEP delivery to better respond to patient needs, including modifying patient flow, pill packaging, and counseling. HCWs believed the biggest challenge to sustained integration and scaling of PrEP for AGYW would be lack of health care worker motivation, primarily due to a misalignment of personal and professional values and expectations. HCWs frequently described concerns of PrEP provision being seen as condoning or promoting unprotected sex among young unmarried, sexually active women. Persuasive techniques used to overcome these reservations included emphasizing the social realities of HIV risk, health care worker professional identities, and vocational commitments to keeping young women healthy. Conclusion: Sustained scale-up of PrEP will require HCWs to value and prioritize its incorporation into daily practice. As with the provision of other SRH services, HCWs may have moral reservations about providing PrEP to AGYW. Strategies that strengthen alignment of HCW personal values with professional goals will be important for strengthening motivation to overcome delivery challenges.
Collapse
Affiliation(s)
- Gabrielle O'Malley
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Stephanie D. Roche
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Elzette Rousseau
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Danielle Travill
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Victor Omollo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Elizabeth A. Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Gena Barnabee
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Julie C. Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jennifer F. Morton
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Rachel E. Johnson
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Connie L. Celum
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| |
Collapse
|
40
|
Pintye J, Kinuthia J, Abuna F, Mugwanya K, Lagat H, Dettinger JC, Odinga D, Sila J, Anderson PL, John-Stewart G, Baeten JM. Frequency and Predictors of Tenofovir-diphosphate Detection Among Young Kenyan Women in a Real-world Pre-exposure Prophylaxis Implementation Program. Clin Infect Dis 2021; 71:e509-e512. [PMID: 32109293 DOI: 10.1093/cid/ciaa181] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/24/2020] [Indexed: 11/12/2022] Open
Abstract
In a pre-exposure prophylaxis program for Kenyan women, we detected tenofovir-diphosphate in 61% (125/201) of randomly selected dried blood spots collected at the first follow-up visit. Tenofovir-diphosphate was detected more frequently among women who had partners living with human immunodeficiency virus, who were not pregnant, and who were ≥24 years.
Collapse
Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Harison Lagat
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Daniel Odinga
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
41
|
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.
Collapse
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
| | | |
Collapse
|
42
|
Wagner AD, Kinuthia J, Dettinger J, Mwongeli N, Gómez L, Watoyi S, Drake AL, Abuna F, Pintye J, Ochieng B, Odinga D, John-Stewart G, Baeten JM. Challenges of Discrepant HIV Tests in Pregnant Women in the PrEP era-to Treat or Not to Treat? J Infect Dis 2021; 223:234-237. [PMID: 32561928 DOI: 10.1093/infdis/jiaa343] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During HIV retesting in antenatal and preexposure prophylaxis (PrEP) care, discrepant results occur, but guidelines are lacking. METHODS In a Kenyan trial implementing antenatal PrEP, if 1 test is reactive, a second is performed; if discrepant, both are repeated; if persistently discrepant, DNA polymerase chain reaction (PCR) is performed. RESULTS Among 4451 women, 23 265 HIV retesting sessions were performed; 14 (0.06%, 95% confidence interval, 0.03%-0.10%) had discrepant results among 10 individuals; in all 10 initial cases, PCR was negative. CONCLUSIONS Discrepant rapid tests are an expected, rare, and important challenge for antenatal care HIV retesting, with and without PrEP. CLINICAL TRIALS REGISTRATION NCT03070600.
Collapse
Affiliation(s)
- Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nancy Mwongeli
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Laurén Gómez
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Salphine Watoyi
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Felix Abuna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ben Ochieng
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Odinga
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
43
|
Pintye J, Huo Y, Kacanek D, Zhang K, Kuncze K, Okochi H, Gandhi M. Detectable HIV RNA in late pregnancy associated with low tenofovir hair levels at time of delivery among women living with HIV in the United States. AIDS 2021; 35:267-274. [PMID: 33055571 PMCID: PMC7775322 DOI: 10.1097/qad.0000000000002730] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated peripartum tenofovir (TFV) exposure via hair measures among women living with HIV in the United States. DESIGN Observational cohort study. METHODS Hair samples were collected at or shortly after childbirth among mothers enrolled in the Surveillance Monitoring for Antiretroviral Therapy Toxicities Study of the Pediatric HIV/AIDS Cohort Study between 6/2014 and 7/2016. Among mothers receiving TFV disoproxil fumarate (TDF)-based regimens during pregnancy, TFV hair concentrations were analyzed using liquid chromatography/tandem mass spectrometry. Weight-normalized TFV concentrations were log10 transformed. Multivariable linear regression assessed correlates of TFV concentrations. RESULTS Overall, 121 mothers on TDF-based antiretroviral therapy during pregnancy had hair specimens tested for TFV concentrations and were included in the analysis. Median age at delivery was 31 years [interquartile range (IQR) 26-36]; 71% self-identified as non-Hispanic black, and 10% had unsuppressed viral loads in late pregnancy (HIV RNA ≥ 400 copies/ml). Median time from birth to hair collection was 3 days (IQR 1-14) and median TFV hair concentration was 0.02 ng/mg (IQR 0.01-0.04). In multivariable models, an unsuppressed viral load in late pregnancy was associated with 80% lower adjusted mean peripartum TFV concentrations than pregnancies with viral suppression (95% confidence interval: -90% to -59%, P < 0.001). Use of TDF only in the first trimester and attaining high school graduation were also associated with lower TFV hair concentrations. CONCLUSION Unsuppressed viral load during late pregnancy was strongly associated with lower maternal TFV hair concentrations at birth, though viremia was rare. Efforts to improve maternal virological outcomes and eliminate vertical HIV transmission could incorporate drug exposure monitoring using hair or other metrics.
Collapse
Affiliation(s)
- Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Yanling Huo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kevin Zhang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Karen Kuncze
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Hideaki Okochi
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
44
|
Ortblad KF, Mogere P, Roche S, Kamolloh K, Odoyo J, Irungu E, Mugo NR, Pintye J, Baeten JM, Bukusi E, Ngure K. Design of a care pathway for pharmacy-based PrEP delivery in Kenya: results from a collaborative stakeholder consultation. BMC Health Serv Res 2020; 20:1034. [PMID: 33176785 PMCID: PMC7661206 DOI: 10.1186/s12913-020-05898-9] [Citation(s) in RCA: 9] [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: 07/31/2020] [Accepted: 11/03/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION In Kenya, pre-exposure prophylaxis (PrEP) for HIV prevention is almost exclusively delivered at HIV clinics. Developing novel PrEP delivery models is important for increasing the reach of PrEP. Delivery of PrEP through pharmacies is one approach utilized in the US to improve accessibility. Retail pharmacies are commonly used as a first-line access point for medical care in Kenya, but have not been utilized for PrEP delivery. We conducted a collaborative consultative meeting of stakeholders to develop a care pathway for pharmacy-based PrEP delivery in Kenya. METHODS In January 2020, we held a one-day meeting in Nairobi with 36 stakeholders from PrEP regulatory, professional, healthcare service delivery, civil society, and research organizations. Attendees reviewed a theory of change model, results from formative qualitative research with pharmacy providers and clients, and anticipated core components of pharmacy-based PrEP delivery: counseling, HIV testing, prescribing, and dispensing. Stakeholders participated in small and large group discussions to identify potential challenges and solutions. We synthesized the key findings from these discussions. RESULTS Stakeholders were enthusiastic about a model for pharmacy-based PrEP delivery. Potential challenges identified included insufficient pharmacy provider knowledge and skills, regulatory hurdles to providing affordable HIV testing at pharmacies, and undefined pathways for PrEP procurement. Potential solutions identified included having pharmacy providers complete the Kenya Ministry of Health-approved PrEP training, use of a PrEP prescribing checklist with remote clinician oversight and provider-assisted HIV self-testing, and having the government provide PrEP and HIV self-testing kits to pharmacies during a pilot test. A care pathway was developed over the course of the meeting. CONCLUSIONS PrEP delivery stakeholders in Kenya were strongly supportive of developing and testing a model for pharmacy-based PrEP delivery to increase PrEP access. We collaboratively developed a care pathway for pilot testing that has the potential to expand PrEP delivery options in Kenya and other similar settings.
Collapse
Affiliation(s)
- Katrina F Ortblad
- Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA.
| | - Peter Mogere
- Partners in Health and Research Development, Thika, Kenya
| | - Stephanie Roche
- Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
| | - Kevin Kamolloh
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Josephine Odoyo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth Irungu
- Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- Partners in Health and Research Development, Thika, Kenya
| | - Nelly R Mugo
- Partners in Health and Research Development, Thika, Kenya
- Sexual Reproductive and Adolescent Child Health Research Program, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jillian Pintye
- Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- School of Nursing, University of Washington, Seattle, USA
| | - Jared M Baeten
- Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Elizabeth Bukusi
- Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA, 98104, USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - Kenneth Ngure
- Partners in Health and Research Development, Thika, Kenya
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| |
Collapse
|
45
|
Larsen A, Kinuthia J, Lagat H, Sila J, Abuna F, Kohler P, John-Stewart G, Pintye J. Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya. Int J STD AIDS 2020; 31:652-664. [PMID: 32538330 DOI: 10.1177/0956462420920423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We assessed prevalence of human immunodeficiency virus (HIV) risk behaviors and depressive symptoms among adolescent girls and young women (AGYW) aged 15-24 years attending four public family planning clinics in Western Kenya from January to June 2019. Moderate-to-severe depression (MSD) was defined as a Center for Epidemiologic Studies Depression Scale (CESD-10) score ≥10. Among 487 AGYW, the median age was 22 years (interquartile range 20-23), and 59 (12%) AGYW reported MSD. MSD was more prevalent among AGYW without a current partner (p = 0.001) and associated with HIV risk factors including partner ≥10 years older, recent transactional sex, forced sex, intimate partner violence, and alcohol use (each p ≤ 0.005). Thirty-four percent of AGYW with MSD had a high HIV risk score corresponding to 5 to 15 incident HIV cases per 100 person-years. Overlapping high prevalence of depression and HIV risk among AGYW underscores the need for integrated mental health and HIV services in family planning clinics.
Collapse
Affiliation(s)
- Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.,Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, USA.,Psychosocial and Community Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,University of Washington, Department of Medicine, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
46
|
Pintye J, Davey DLJ, Wagner AD, John-Stewart G, Baggaley R, Bekker LG, Celum C, Chi BH, Coates TJ, Groves AK, Haberer JE, Heffron R, Kinuthia J, Matthews LT, McIntyre JA, Moodley D, Mofenson LM, Mugo N, Mujugira A, Myer L, Shoptaw S, Stranix-Chibanda L, Baeten JM. Defining gaps in pre-exposure prophylaxis delivery for pregnant and post-partum women in high-burden settings using an implementation science framework. Lancet HIV 2020; 7:e582-e592. [PMID: 32763221 DOI: 10.1016/s2352-3018(20)30102-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 01/01/2023]
Abstract
Pregnancy is a high-risk period for HIV acquisition in African women, and pregnant women who become acutely infected with HIV account for up to a third of vertical HIV transmission cases in African settings. To protect women and eliminate vertical transmission, WHO recommends offering oral pre-exposure prophylaxis (PrEP) based on tenofovir to HIV-negative pregnant and post-partum women with a substantial risk of HIV acquisition. PrEP implementation for pregnant and post-partum women lags behind implementation for other high-risk populations. Unique considerations for PrEP implementation arise during pregnancy and post partum, including the integration of provider training with clinical delivery and monitoring of PrEP exposure and outcomes within existing maternal health systems, yet scarce implementation data are available to generate evidence in this context.
Collapse
Affiliation(s)
- Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Dvora L Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas J Coates
- Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Lynn T Matthews
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - James A McIntyre
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Anova Health Institute, Johannesburg, South Africa
| | | | | | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA; Kenya Medical Research Institute (KEMRI), Center for Clinical Research, Nairobi, Kenya
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA, USA; Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Steven Shoptaw
- Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
47
|
Sila J, Larsen AM, Kinuthia J, Owiti G, Abuna F, Kohler PK, John-Stewart G, Pintye J. High Awareness, Yet Low Uptake, of Pre-Exposure Prophylaxis Among Adolescent Girls and Young Women Within Family Planning Clinics in Kenya. AIDS Patient Care STDS 2020; 34:336-343. [PMID: 32757980 DOI: 10.1089/apc.2020.0037] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Adolescent girls and young women (AGYW) are a priority population for HIV prevention in high-burden settings. We evaluated psychosocial characteristics, behavioral risk factors for HIV, and pre-exposure prophylaxis (PrEP) awareness and uptake among AGYW seeking contraceptive services at four public sector family planning (FP) clinics offering integrated PrEP delivery in Kisumu, Kenya. From October 2018 to June 2019, we approached all AGYW (aged 15-24 years) seeking contraception to participate in a survey following receipt of FP services and PrEP screening. Overall, 470 AGYW were screened for PrEP at their FP visit by facility staff and subsequently enrolled in the survey. Median age was 22 years (interquartile range 20-23), 22% of AGYW were in school, and 55% were married. The most frequent forms of contraception were implants and injectables (41% each). Over a third of AGYW (36%) reported low social support, 13% had symptoms of moderate to severe depression, and 3% reported intimate partner violence. Three-quarters (75%) of AGYW reported recent condomless sex and 42% suspected that their primary partner had other sexual partners. Most AGYW (89%) had previously heard of PrEP; 76% had at least one PrEP eligibility criterion as per national guidelines; however, only 4% initiated PrEP at their current FP visit. PrEP initiators more frequently had high HIV risk perception than noninitiators (85% vs. 10%, p < 0.001). Low perceived HIV risk (76%) and pill burden (51%) were common reasons for declining PrEP among AGYW with HIV behavioral risk factors. PrEP counseling should be tailored to AGYW to guide appropriate PrEP decision-making in this important population.
Collapse
Affiliation(s)
| | - Anna M. Larsen
- Department of Epidemiology and University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Pamela K. Kohler
- Department of Global Health, University of Washington, Seattle, Washington, USA
- University of Washington Child, Family, and Population Health, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Epidemiology and University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, and University of Washington, Seattle, Washington, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| |
Collapse
|
48
|
Pintye J, Huo Y, Kacanek D, Zhang K, Kuncze K, Okochi H, Gandhi M. Extent of In Utero Transfer of Tenofovir From Mother to Fetus: A Paired Analysis of Hair Specimens Collected at Birth From a Cohort in the United States. J Infect Dis 2020; 223:638-644. [PMID: 32620015 PMCID: PMC7904286 DOI: 10.1093/infdis/jiaa398] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/26/2020] [Indexed: 11/15/2022] Open
Abstract
Understanding in utero transfer of antiretrovirals is critical for interpreting safety. Hair levels measure cumulative exposure. We measured tenofovir (TFV) concentrations in hair at delivery among women living with human immunodeficiency virus receiving TFV disoproxil fumarate-based treatment and their infants, using liquid chromatography-tandem mass spectrometry. Among 103 mother-infant pairs, the mean log10 ratio of infant-to-maternal TFV levels was 1.08 (95% confidence interval, .97-1.20). TFV transfer was 60% lower from mothers who had preterm compared with term deliveries and 42% lower from mothers who had cesarean compared with vaginal deliveries. Like prior studies assessing transfer via short-term measures (plasma, cord blood, amniotic fluid), we found high cumulative transfer using hair.
Collapse
Affiliation(s)
- Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Yanling Huo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kevin Zhang
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Karen Kuncze
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Hideaki Okochi
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Monica Gandhi
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
49
|
Larsen A, Wilson KS, Kinuthia J, John-Stewart G, Richardson BA, Pintye J, Abuna F, Lagat H, Owens T, Kohler P. Standardised patient encounters to improve quality of counselling for pre-exposure prophylaxis (PrEP) in adolescent girls and young women (AGYW) in Kenya: study protocol of a cluster randomised controlled trial. BMJ Open 2020; 10:e035689. [PMID: 32565464 PMCID: PMC7311012 DOI: 10.1136/bmjopen-2019-035689] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/03/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) in sub-Saharan Africa are at high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP) demonstration projects observe that AGYW uptake and adherence to PrEP during risk periods is suboptimal. Judgemental interactions with healthcare workers (HCW) and inadequate counselling can be barriers to PrEP use among AGYW. Improving HCW competency and communication to support PrEP delivery to AGYW requires new strategies. METHODS AND ANALYSIS PrEP Implementation for Young Women and Adolescents Program-standardised patient (PrIYA-SP) is a cluster randomised trial of a standardised patient actor (SP) training intervention designed to improve HCW adherence to PrEP guidelines and communication skills. We purposively selected 24 clinics offering PrEP services under fully programmatic conditions in Kisumu County, Kenya. At baseline, unannounced SP 'mystery shoppers' present to clinics portraying AGYW in common PrEP scenarios for a cross-sectional assessment of PrEP delivery. Twelve facilities will be randomised to receive a 2-day training intervention, consisting of lectures, role-playing with SPs and group debriefing. Unannounced SPs will repeat the assessment in all 24 sites following the intervention. The primary outcome is quality of PrEP counselling, including adherence to national guidelines and communication skills, scored on a checklist by SPs blinded to intervention assignment. An intention-to-treat (ITT) analysis will evaluate whether the intervention resulted in higher scores within intervention compared with control facilities, adjusted for baseline SP scores and accounting for clustering by facility. We hypothesise that the intervention will improve quality of PrEP counselling compared with standard of care. Results from this study will inform guidelines for PrEP delivery to AGYW in low-resource settings and offer a potentially scalable strategy to improve service delivery for this high-risk group. ETHICS AND DISSEMINATION The protocol was approved by institutional review boards at Kenyatta National Hospital and University of Washington. An external advisory committee monitors social harms. Results will be disseminated through peer-reviewed journals and presentations. TRIAL REGISTRATION NUMBER NCT03875950.
Collapse
Affiliation(s)
- Anna Larsen
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Kate S Wilson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Research and Programs, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - G John-Stewart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - B A Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Felix Abuna
- Research and Programs, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - Harison Lagat
- Research and Programs, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - Tamara Owens
- Health Sciences Simulation & Clinical Skills Center, Howard University, Seattle, Washington, DC, USA
| | - Pamela Kohler
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| |
Collapse
|
50
|
Pintye J, Baeten JM. Benefits of male circumcision for MSM: evidence for action. Lancet Glob Health 2020; 7:e388-e389. [PMID: 30879496 DOI: 10.1016/s2214-109x(19)30038-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA 98104, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA 98104, USA; Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA.
| |
Collapse
|