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Tran DN, Ching J, Kafu C, Wachira J, Koros H, Venkataramani M, Said J, Pastakia SD, Galárraga O, Genberg BL. Interruptions to HIV Care Delivery During Pandemics and Natural Disasters: A Qualitative Study of Challenges and Opportunities From Frontline Healthcare Providers in Western Kenya. J Int Assoc Provid AIDS Care 2023; 22:23259582231152041. [PMID: 36718505 PMCID: PMC9893388 DOI: 10.1177/23259582231152041] [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] [Indexed: 02/01/2023] Open
Abstract
During public health crises, people living with HIV (PLWH) may become disengaged from care. The goal of this study was to understand the impact of the COVID-19 pandemic and recent flooding disasters on HIV care delivery in western Kenya. We conducted ten individual in-depth interviews with HIV providers across four health facilities. We used an iterative and integrated inductive and deductive data analysis approach to generate four themes. First, increased structural interruptions created exacerbating strain on health facilities. Second, there was increased physical and psychosocial burnout among providers. Third, patient uptake of services along the HIV continuum decreased, particularly among vulnerable patients. Finally, existing community-based programs and teleconsultations could be adapted to provide differentiated HIV care. Community-centric care programs, with an emphasis on overcoming the social, economic, and structural barriers will be crucial to ensure optimal care and limit the impact of public health disruptions on HIV care globally.
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Affiliation(s)
- Dan N Tran
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA.,The 430902Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Jennifer Ching
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Catherine Kafu
- The 430902Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Department of Media Studies, University of Witwatersrand School of Literature, Language and Media, Johannesburg, South Africa
| | - Juddy Wachira
- Department of Mental Health & Behavioral Sciences, 130188Moi University School of Medicine, Eldoret, Kenya
| | - Hillary Koros
- The 430902Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Maya Venkataramani
- Department of Medicine, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jamil Said
- The 430902Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Department of Human Anatomy, 130188Moi University School of Medicine, Eldoret, Kenya
| | - Sonak D Pastakia
- The 430902Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Center for Health Equity and Innovation, Purdue University School of Pharmacy, Indianapolis, IN, USA
| | - Omar Galárraga
- Department of Health Services, Policy & Practice, 174610Brown University School of Public Health, Providence, RI, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
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2
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Gonzalvo JD, Meredith AH, Pastakia SD, Peters M, Eberle M, Schmelz AN, Pence L, Triboletti JS, Walroth TA. Changes in clinical markers observed from pharmacist-managed cardiovascular risk reduction clinics in federally qualified health centers: A retrospective cohort study. PLoS One 2023; 18:e0282940. [PMID: 36920963 PMCID: PMC10016666 DOI: 10.1371/journal.pone.0282940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Reductions in hemoglobin A1c (HbA1C) have been associated with improved cardiovascular outcomes and savings in medical expenditures. One public health approach has involved pharmacists within primary care settings. The objective was to assess change in HbA1C from baseline after 3-5 months of follow up in pharmacist-managed cardiovascular risk reduction (CVRR) clinics. METHODS This retrospective cohort chart review occurred in eight pharmacist-managed CVRR federally qualified health clinics (FQHC) in Indiana, United States. Data were collected from patients seen by a CVRR pharmacist within the timeframe of January 1, 2015 through February 28, 2020. Data collected include: demographic characteristics and clinical markers between baseline and follow-up. HbA1C from baseline after 3 to 5 months was assessed with pared t-tests analysis. Other clinical variables were assessed and additional analysis were performed at 6-8 months. Additional results are reported between 9 months and 36 months of follow up. RESULTS The primary outcome evaluation included 445 patients. Over 36 months of evaluation, 3,803 encounters were described. Compared to baseline, HbA1C was reduced by 1.6% (95%CI -1.8, -1.4, p<0.01) after 3-5 months of CVRR care. Reductions in HbA1C persisted at 6-8 months with a reduction of 1.8% ([95%CI -2.0, -1.5] p<0.01). The follow-up losses were 29.5% at 3-5 months and 93.2% at 33-36 months. CONCLUSIONS Our study augments the existing literature by demonstrating the health improvement of pharmacist-managed CVRR clinics. The great proportion of loss to follow-up is a limitation of this study to be considered. Additional studies exploring the expansion of similar models may amplify the public health impact of pharmacist-managed CVRR services in primary care sites.
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Affiliation(s)
- Jasmine D. Gonzalvo
- Purdue University College of Pharmacy, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Ashley H. Meredith
- Purdue University College of Pharmacy, Indianapolis, Indiana, United States of America
| | - Sonak D. Pastakia
- Purdue University College of Pharmacy, Indianapolis, Indiana, United States of America
| | - Michael Peters
- Eskenazi Health, Indianapolis, Indiana, United States of America
| | - Madilyn Eberle
- Purdue University College of Pharmacy, Indianapolis, Indiana, United States of America
| | - Andrew N. Schmelz
- Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana, United States of America
| | - Lauren Pence
- Eskenazi Health, Indianapolis, Indiana, United States of America
| | - Jessica S. Triboletti
- Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana, United States of America
| | - Todd A. Walroth
- Eskenazi Health, Indianapolis, Indiana, United States of America
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3
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Njuguna D, Nwaneri F, Prichard AC, Manji I, Kigen G, Busakhala N, Nyanje S, O'Neil E, Pastakia SD. Risk of Bleeding Associated With Outpatient Use of Rivaroxaban in VTE Management at a National Referral Hospital in Western Kenya. Clin Appl Thromb Hemost 2023; 29:10760296231184216. [PMID: 37448336 DOI: 10.1177/10760296231184216] [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] [Indexed: 07/15/2023] Open
Abstract
There is limited data on the bleeding safety profile of direct oral anticoagulants, such as rivaroxaban, in low- and middle-income country settings like Kenya. In this prospective observational study, patients newly started on rivaroxaban or switching to rivaroxaban from warfarin for the management of venous thromboembolism (VTE) within the national referral hospital in western Kenya were assessed to determine the frequency of bleeding during treatment. Bleeding events were assessed at the 1- and 3-month visits, as well as at the end of follow-up. The International Society of Thrombosis and Hemostasis (ISTH) and the Bleeding Academic Research Consortium (BARC) criteria were used to categorize the bleeding events, and descriptive statistics were used to summarize categorical variables. Univariate and multivariate logistic regression model was used to calculate unadjusted and adjusted associations between patient characteristics and bleeding. The frequency of any type of bleeding was 14.4% (95% CI: 9.3%-20.8%) for an incidence rate of 30.9 bleeding events (95% CI: 20.1-45.6) per 100 patient-years of follow-up. The frequency of major bleeding was 1.9% while that of clinically relevant non-major bleeding was 13.8%. In the multivariate logistic regression model, being a beneficiary of the national insurance plan was associated with a lower risk of bleeding, while being unemployed was associated with a higher bleeding risk. The use of rivaroxaban in the management of VTE was associated with a higher frequency of bleeding. These findings warrant confirmation in larger and more targeted investigations in a similar population.
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Affiliation(s)
- Dennis Njuguna
- Department of Pharmacology and Toxicology, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Francis Nwaneri
- College of Health Sciences, School of Medicine, Indiana University, Bloomington, IN, USA
| | | | - Imran Manji
- Moi Teaching and Referral Hospital, Directorate of Pharmacy and Nutrition, Eldoret, Kenya
| | - Gabriel Kigen
- Department of Pharmacology and Toxicology, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Naftali Busakhala
- Department of Pharmacology and Toxicology, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Samuel Nyanje
- Moi Teaching and Referral Hospital, Directorate of Pharmacy and Nutrition, Eldoret, Kenya
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4
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Kafu C, Wachira J, Omodi V, Said J, Pastakia SD, Tran DN, Onyango JA, Aburi D, Wilson-Barthes M, Galárraga O, Genberg BL. Integrating community-based HIV and non-communicable disease care with microfinance groups: a feasibility study in Western Kenya. Pilot Feasibility Stud 2022; 8:266. [PMID: 36578093 PMCID: PMC9795156 DOI: 10.1186/s40814-022-01218-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Harambee study is a cluster randomized trial in Western Kenya that tests the effect, mechanisms, and cost-effectiveness of integrating community-based HIV and non-communicable disease care within microfinance groups on chronic disease treatment outcomes. This paper documents the stages of our feasibility study conducted in preparation for the Harambee trial, which include (1) characterizing the target population and gauging recruitment capacity, (2) determining community acceptability of the integrated intervention and study procedures, and (3) identifying key implementation considerations prior to study start. METHODS Feasibility research took place between November 2019 and February 2020 in Western Kenya. Mixed methods data collection included surveys administered to 115 leaders of 105 community-based microfinance groups, 7 in-person meetings and two workshops with stakeholders from multiple sectors of the health system, and ascertainment of field notes and geographic coordinates for group meeting locations and HIV healthcare facilities. Quantitative survey data were analyzed using STATA IC/13. Longitude and latitude coordinates were mapped to county boundaries using Esri ArcMap. Qualitative data obtained from stakeholder meetings and field notes were analyzed thematically. RESULTS Of the 105 surveyed microfinance groups, 77 met eligibility criteria. Eligible groups had been in existence from 6 months to 18 years and had an average of 22 members. The majority (64%) of groups had at least one member who owned a smartphone. The definition of "active" membership and model of saving and lending differed across groups. Stakeholders perceived the community-based intervention and trial procedures to be acceptable given the minimal risks to participants and the potential to improve HIV treatment outcomes while facilitating care integration. Potential challenges identified by stakeholders included possible conflicts between the trial and existing community-based interventions, fear of group disintegration prior to trial end, clinicians' inability to draw blood for viral load testing in the community, and deviations from standard care protocols. CONCLUSIONS This study revealed that it was feasible to recruit the number of microfinance groups necessary to ensure that our clinical trial was sufficient powered. Elicitation of stakeholder feedback confirmed that the planned intervention was largely acceptable and was critical to identifying challenges prior to implementation. TRIAL REGISTRATION The original trial was prospectively registered with ClinicalTrials.gov (NCT04417127) on 4 June 2020.
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Affiliation(s)
- Catherine Kafu
- Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya. .,School of Literature, Language and Media, Department of Media Studies, University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa.
| | - Juddy Wachira
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256School of Medicine, Department of Behavioral Science, Moi University College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Victor Omodi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Jamil Said
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256School of Medicine, Department of Human Anatomy, Moi University College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Sonak D. Pastakia
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.169077.e0000 0004 1937 2197Center for Health Equity and Innovation, Purdue University College of Pharmacy, 640 Eskenazi Ave, Indianapolis, IN 46202 USA
| | - Dan N. Tran
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.264727.20000 0001 2248 3398Department of Pharmacy Practice, Temple University School of Pharmacy, 3307 N Broad St, Philadelphia, PA 19140 USA
| | - Jael Adongo Onyango
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Dan Aburi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Marta Wilson-Barthes
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912 USA
| | - Omar Galárraga
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912 USA
| | - Becky Lynn Genberg
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Karwa R, Schellhase E, Malati CY, Pastakia SD, Manji I, Samuel JM, Miller ML. Implementation of a Global Health Equity Fellowship Established in Partnership Between an Academic Institution and Governmental Agency. J Am Coll Clin Pharm 2022. [DOI: 10.1002/jac5.1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rakhi Karwa
- Purdue University College of Pharmacy Indianapolis Indiana
| | | | | | | | - Imran Manji
- Moi Teaching and Referral Hospital Eldoret Kenya
| | - Jeffrey M. Samuel
- Purdue University College of Pharmacy
- United States Agency for International Development Springfield Virginia
| | - Monica L. Miller
- Purdue University College of Pharmacy Indianapolis Indiana
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Ave Indianapolis IN
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6
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Tran DN, Kangogo K, Amisi JA, Kamadi J, Karwa R, Kiragu B, Laktabai J, Manji IN, Njuguna B, Szkwarko D, Qian K, Vedanthan R, Pastakia SD. Community-based medication delivery program for antihypertensive medications improves adherence and reduces blood pressure. PLoS One 2022; 17:e0273655. [PMID: 36084087 PMCID: PMC9462824 DOI: 10.1371/journal.pone.0273655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Non-adherence to antihypertensive medications is a major cause of uncontrolled hypertension, leading to cardiovascular morbidity and mortality. Ensuring consistent medication possession is crucial in addressing non-adherence. Community-based medication delivery is a strategy that may improve medication possession, adherence, and blood pressure (BP) reduction. Our program in Kenya piloted a community medication delivery program, coupled with blood pressure monitoring and adherence evaluation. Between September 2019 and March 2020, patients who received hypertension care from our chronic disease management program also received community-based delivery of antihypertensive medications. We calculated number of days during which each patient had possession of medications and analyzed the relationship between successful medication delivery and self-reported medication adherence and BP. A total of 128 patient records (80.5% female) were reviewed. At baseline, mean systolic blood pressure (SBP) was 155.7 mmHg and mean self-reported adherence score was 2.7. Sixty-eight (53.1%) patients received at least 1 successful medication delivery. Our pharmacy dispensing records demonstrated that medication possession was greater among patients receiving medication deliveries. Change in self-reported medication adherence from baseline worsened in patients who did not receive any medication delivery (+0.5), but improved in patients receiving 1 delivery (-0.3) and 2 or more deliveries (-0.8). There was an SBP reduction of 1.9, 6.1, and 15.5 mmHg among patients who did not receive any deliveries, those who received 1 delivery, and those who received 2 or more medication deliveries, respectively. Adjusted mixed-effect model estimates revealed that mean SBP reduction and self-reported medication adherence were improved among individuals who successfully received medication deliveries, compared to those who did not. A community medication delivery program in western Kenya was shown to be implementable and enhanced medication possession, reduced SBP, and significantly improved self-reported adherence. This is a promising strategy to improve health outcomes for patients with uncontrolled hypertension that warrants further investigation.
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Affiliation(s)
- Dan N. Tran
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, United States of America
| | - Kibet Kangogo
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - James A. Amisi
- Department of Family Medicine, Medical Education and Community Health, Moi University School of Medicine, Eldoret, Kenya
| | - James Kamadi
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Rakhi Karwa
- Department of Pharmacy Practice, Purdue University School of Pharmacy, Indianapolis, Indiana, United States of America
| | - Benson Kiragu
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jeremiah Laktabai
- Department of Family Medicine, Medical Education and Community Health, Moi University School of Medicine, Eldoret, Kenya
| | - Imran N. Manji
- Department of Clinical Pharmacy and Practice, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Benson Njuguna
- Department of Clinical Pharmacy and Practice, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Daria Szkwarko
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Kun Qian
- Department of Population Health, NYU Grossman School of Medicine, New York, United States of America
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, United States of America
| | - Sonak D. Pastakia
- Department of Pharmacy Practice, Purdue University School of Pharmacy, Indianapolis, Indiana, United States of America
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Kiplagat J, Tran DN, Barber T, Njuguna B, Vedanthan R, Triant VA, Pastakia SD. How health systems can adapt to a population ageing with HIV and comorbid disease. Lancet HIV 2022; 9:e281-e292. [PMID: 35218734 DOI: 10.1016/s2352-3018(22)00009-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
As people age with HIV, their needs increase beyond solely managing HIV care. Ageing people with HIV, defined as people with HIV who are 50 years or older, face increased risk of both age-regulated comorbidities and ageing-related issues. Globally, health-care systems have struggled to meet these changing needs of ageing people with HIV. We argue that health systems need to rethink care strategies to meet the growing needs of this population and propose models of care that meet these needs using the WHO health system building blocks. We focus on care provision for ageing people with HIV in the three different funding mechanisms: President's Emergency Plan for AIDS Relief and Global Fund funded nations, the USA, and single-payer government health-care systems. Although our categorisation is necessarily incomplete, our efforts provide a valuable contribution to the debate on health systems strengthening as the need for integrated, people-centred, health services increase.
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Affiliation(s)
| | - Dan N Tran
- Academic Model Providing Access to Healthcare, Eldoret, Kenya; Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA
| | - Tristan Barber
- Department of HIV Medicine, Ian Charleson Day Centre, Royal Free Hospital, London, UK
| | - Benson Njuguna
- Academic Model Providing Access to Healthcare, Eldoret, Kenya; Department of Clinical Pharmacy and Practice, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rajesh Vedanthan
- Academic Model Providing Access to Healthcare, Eldoret, Kenya; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Virginia A Triant
- Divisions of Infectious Diseases and General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sonak D Pastakia
- Academic Model Providing Access to Healthcare, Eldoret, Kenya; Center for Health Equity and Innovation, College of Pharmacy, Purdue University, Indianapolis, IN, USA.
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Thakkar A, Valente T, Andesia J, Njuguna B, Miheso J, Mercer T, Mugo R, Mwangi A, Mwangi E, Pastakia SD, Pathak S, Pillsbury MKM, Kamano J, Naanyu V, Williams M, Vedanthan R, Akwanalo C, Bloomfield GS. Network characteristics of a referral system for patients with hypertension in Western Kenya: results from the Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) study. BMC Health Serv Res 2022; 22:315. [PMID: 35255913 PMCID: PMC8903732 DOI: 10.1186/s12913-022-07699-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Health system approaches to improve hypertension control require an effective referral network. A national referral strategy exists in Kenya; however, a number of barriers to referral completion persist. This paper is a baseline assessment of a hypertension referral network for a cluster-randomized trial to improve hypertension control and reduce cardiovascular disease risk. METHODS We used sociometric network analysis to understand the relationships between providers within a network of nine geographic clusters in western Kenya, including primary, secondary, and tertiary care facilities. We conducted a survey which asked providers to nominate individuals and facilities to which they refer patients with controlled and uncontrolled hypertension. Degree centrality measures were used to identify providers in prominent positions, while mixed-effect regression models were used to determine provider characteristics related to the likelihood of receiving referrals. We calculated core-periphery correlation scores (CP) for each cluster (ideal CP score = 1.0). RESULTS We surveyed 152 providers (physicians, nurses, medical officers, and clinical officers), range 10-36 per cluster. Median number of hypertensive patients seen per month was 40 (range 1-600). While 97% of providers reported referring patients up to a more specialized health facility, only 55% reported referring down to lower level facilities. Individuals were more likely to receive a referral if they had higher level of training, worked at a higher level facility, were male, or had more job experience. CP scores for provider networks range from 0.335 to 0.693, while the CP scores for the facility networks range from 0.707 to 0.949. CONCLUSIONS This analysis highlights several points of weakness in this referral network including cluster variability, poor provider linkages, and the lack of down referrals. Facility networks were stronger than provider networks. These shortcomings represent opportunities to focus interventions to improve referral networks for hypertension. TRIAL REGISTRATION Trial Registered on ClinicalTrials.gov NCT03543787 , June 1, 2018.
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Affiliation(s)
- Aarti Thakkar
- grid.26009.3d0000 0004 1936 7961Duke University School of Medicine, 300 West Morgan Street, Durham, NC 27701 USA
| | - Thomas Valente
- grid.42505.360000 0001 2156 6853University of Southern California, Los Angeles, CA USA
| | - Josephine Andesia
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Juliet Miheso
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tim Mercer
- grid.89336.370000 0004 1936 9924The University of Texas at Austin Dell Medical School, Austin, TX USA
| | - Richard Mugo
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ann Mwangi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256College of Health Sciences, Moi University, Eldoret, Kenya
| | - Eunice Mwangi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak D. Pastakia
- grid.169077.e0000 0004 1937 2197College of Pharmacy, Purdue University, West Lafayette, IN USA
| | - Shravani Pathak
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mt. Sinai, New York, NY USA
| | - Mc Kinsey M. Pillsbury
- grid.266102.10000 0001 2297 6811University of California San Francisco School of Medicine, San Francisco, CA USA
| | - Jemima Kamano
- Moi Teaching and Referral Hospital, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256College of Health Sciences, Moi University, Eldoret, Kenya
| | - Violet Naanyu
- grid.79730.3a0000 0001 0495 4256College of Health Sciences, Moi University, Eldoret, Kenya
| | - Makeda Williams
- grid.279885.90000 0001 2293 4638National Heart, Lung and Blood Institute, Bethesda, MD USA
| | - Rajesh Vedanthan
- grid.240324.30000 0001 2109 4251New York University, Grossman School of Medicine, New York, NY USA
| | | | - Gerald S. Bloomfield
- grid.26009.3d0000 0004 1936 7961Duke University School of Medicine, 300 West Morgan Street, Durham, NC 27701 USA
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Pastakia SD, Clark A, Lewis K, Taugher D, Patel R, Ali L, Wu C, Butler R, Bateman MT, McCarthy C, Vargas J, Poulsom C. The impact of clinical pharmacist led comprehensive medication management on diabetes care at Federally Qualified Health Centers within the
BD
Helping Build Healthy Communities
program. J Am Coll Clin Pharm 2022. [DOI: 10.1002/jac5.1586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sonak D. Pastakia
- Purdue University Center for Health Equity and Innovation Indianapolis Indiana USA
| | | | | | | | - Rajal Patel
- Mountain Park Health Center Phoenix Arizona USA
| | - Liz Ali
- North County Health Project Inc., d.b.a. TrueCare San Marcos California USA
| | - Cecilia Wu
- Queenscare Health Centers Los Angeles California USA
| | | | | | | | | | - Carrie Poulsom
- Family Health Centers of Southwest Florida, Inc Fort Myers Florida USA
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10
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Chang AY, Karwa R, Odhiambo H, Were P, Fletcher SL, Tonui EC, Kohn MA, Lee J, Chang D, Lensing S, Namaemba DF, Busakhala N, Kiprono SK, Maurer T, Goodrich S, Pastakia SD. Compression Therapy for HIV-Associated Kaposi Sarcoma Leg Lymphedema: Results of the Kenyan Improvised Compression for Kaposi Sarcoma Randomized Controlled Trial. JCO Glob Oncol 2022; 8:e2100329. [PMID: 35025687 PMCID: PMC8769101 DOI: 10.1200/go.21.00329] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/19/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evaluate the effectiveness of compression while receiving chemotherapy compared with chemotherapy alone in the treatment of HIV-associated Kaposi sarcoma (KS) lymphedema. METHODS A randomized controlled trial was conducted in a single oncology clinic in western Kenya (NCT03404297). A computer-generated randomization schedule was used to allocate treatment arms. Randomized block design was used for stratification by lymphedema stage. Participants were HIV positive adults age ≥ 18 years on antiretroviral therapy with biopsy-proven KS associated with leg lymphedema and being initiated on chemotherapy. The intervention was 10 weeks of weekly clinic-based application of two-component paste compression bandages. The primary outcome was change in the Lower Extremity Lymphedema Index (LELI) score from week 0 to week 14. The secondary outcomes were change in the Lymphedema Quality of Life measure (LYMQOL) and change in the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 score from week 0 to week 14. Blinded outcome assessments were conducted. RESULTS Of 30 participants randomly assigned, 25 eligible patients (chemotherapy [control], n = 13; compression plus chemotherapy [intervention], n = 12) returned at week 14. Change in LELI, LYMQOL, and EORTC QLQ-C30 scores between week 14 and week 0 did not significantly differ by arm. The mean (standard deviation) change in LELI score was -25.9 (34.6) for the control arm compared with -13.3 (29.5) for the intervention arm, P = .340. The difference (95% CI) in the change in LELI score was -12.6 (-39.3 to 14.1). CONCLUSION Future studies evaluating a 14-week change in LELI for KS lymphedema should assume a standard deviation of approximately 30. Lessons learned from this pilot trial should inform the development of a larger, multicenter trial to evaluate the effectiveness of compression for KS lymphedema.
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Affiliation(s)
- Aileen Y Chang
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Dermatology, San Francisco, CA
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | - Rakhi Karwa
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, Indianapolis, IN
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
| | - Haji Odhiambo
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | - Phelix Were
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | | | - Edith C Tonui
- Kericho County Referral Hospital, Pharmacy Department, Kericho, Kenya
| | - Michael A Kohn
- University of California, San Francisco School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, CA
| | - Jeannette Lee
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | - Di Chang
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | - Shelly Lensing
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | | | - Naftali Busakhala
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
| | - Samson K Kiprono
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Moi University School of Medicine, Department of Medicine, Eldoret, Kenya
| | - Toby Maurer
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Indiana University School of Medicine, Department of Dermatology, Indianapolis, IN
| | - Suzanne Goodrich
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Indiana University School of Medicine, Department of Medicine, Division of Infectious Diseases, Indianapolis, IN
| | - Sonak D Pastakia
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, Indianapolis, IN
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
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11
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Pillsbury MKM, Mwangi E, Andesia J, Njuguna B, Bloomfield GS, Chepchumba A, Kamano J, Mercer T, Miheso J, Pastakia SD, Pathak S, Thakkar A, Naanyu V, Akwanalo C, Vedanthan R. Human-centered implementation research: a new approach to develop and evaluate implementation strategies for strengthening referral networks for hypertension in western Kenya. BMC Health Serv Res 2021; 21:910. [PMID: 34479556 PMCID: PMC8414706 DOI: 10.1186/s12913-021-06930-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Human-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial. Methods We organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey. Results The design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions. Conclusions The adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings. Trial registration Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015, Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06930-2.
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Affiliation(s)
- Mc Kinsey M Pillsbury
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Eunice Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Andesia
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | | | - Agneta Chepchumba
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jemima Kamano
- Moi Teaching and Referral Hospital, Eldoret, Kenya.,College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Juliet Miheso
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak D Pastakia
- Center for Health Equity and Innovation, Purdue University, West Lafayette, IN, USA
| | | | | | - Violet Naanyu
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | | | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, New York, NY, 10016, USA.
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12
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Ruchman SG, Delong AK, Kamano JH, Bloomfield GS, Chrysanthopoulou SA, Fuster V, Horowitz CR, Kiptoo P, Matelong W, Mugo R, Naanyu V, Orango V, Pastakia SD, Valente TW, Hogan JW, Vedanthan R. Egocentric social network characteristics and cardiovascular risk among patients with hypertension or diabetes in western Kenya: a cross-sectional analysis from the BIGPIC trial. BMJ Open 2021; 11:e049610. [PMID: 34475172 PMCID: PMC8413931 DOI: 10.1136/bmjopen-2021-049610] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Management of cardiovascular disease (CVD) is an urgent challenge in low-income and middle-income countries, and interventions may require appraisal of patients' social networks to guide implementation. The purpose of this study is to determine whether egocentric social network characteristics (SNCs) of patients with chronic disease in western Kenya are associated with overall CVD risk and individual CVD risk factors. DESIGN Cross-sectional analysis of enrollment data (2017-2018) from the Bridging Income Generation with GrouP Integrated Care trial. Non-overlapping trust-only, health advice-only and multiplex (trust and health advice) egocentric social networks were elicited for each participant, and SNCs representing social cohesion were calculated. SETTING 24 communities across four counties in western Kenya. PARTICIPANTS Participants (n=2890) were ≥35 years old with diabetes (fasting glucose ≥7 mmol/L) or hypertension. PRIMARY AND SECONDARY OUTCOMES We hypothesised that SNCs would be associated with CVD risk status (QRISK3 score). Secondary outcomes were individual CVD risk factors. RESULTS Among the 2890 participants, 2020 (70%) were women, and mean (SD) age was 60.7 (12.1) years. Forty-four per cent of participants had elevated QRISK3 score (≥10%). No relationship was observed between QRISK3 level and SNCs. In unadjusted comparisons, participants with any individuals in their trust network were more likely to report a good than a poor diet (41% vs 21%). SNCs for the trust and multiplex networks accounted for a substantial fraction of variation in measures of dietary quality and physical activity (statistically significant via likelihood ratio test, adjusted for false discovery rate). CONCLUSION SNCs indicative of social cohesion appear to be associated with individual behavioural CVD risk factors, although not with overall CVD risk score. Understanding how SNCs of patients with chronic diseases relate to modifiable CVD risk factors could help inform network-based interventions. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT02501746; https://clinicaltrials.gov/ct2/show/NCT02501746.
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Affiliation(s)
- Samuel G Ruchman
- Department of Medicine, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Allison K Delong
- Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jemima H Kamano
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | | | | | - Valentin Fuster
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Carol R Horowitz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Winnie Matelong
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Richard Mugo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Violet Naanyu
- Department of Sociology, Psychology and Anthropology, School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak D Pastakia
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
| | - Thomas W Valente
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Joseph W Hogan
- Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, USA
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13
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Dong R, Leung C, Naert MN, Naanyu V, Kiptoo P, Matelong W, Matini E, Orango V, Bloomfield GS, Edelman D, Fuster V, Manyara S, Menya D, Pastakia SD, Valente T, Kamano J, Horowitz CR, Vedanthan R. Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya. PLoS One 2021; 16:e0248496. [PMID: 34097700 PMCID: PMC8183981 DOI: 10.1371/journal.pone.0248496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known. METHODS Two types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes. RESULTS We conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. In the context of poverty and previous experiences with the health system, participants described challenges to NCD care across three themes: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility. However, they also outlined windows of opportunity and facilitators of group medical visits and microfinance to address those challenges. DISCUSSION Our qualitative study revealed actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also described opportunities to address and mitigate the impact of these factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide.
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Affiliation(s)
- Rae Dong
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Claudia Leung
- Duke University Medical Center, Durham, North Carolina, United States of America
| | - Mackenzie N. Naert
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Winnie Matelong
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Esther Matini
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Gerald S. Bloomfield
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - David Edelman
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Simon Manyara
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Sonak D. Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, West Lafayette, Indiana, United States of America
| | - Tom Valente
- Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Jemima Kamano
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - Carol R. Horowitz
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Rajesh Vedanthan
- NYU Grossman School of Medicine, New York, NY, United States of America
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14
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Vedanthan R, Kamano JH, Chrysanthopoulou SA, Mugo R, Andama B, Bloomfield GS, Chesoli CW, DeLong AK, Edelman D, Finkelstein EA, Horowitz CR, Manyara S, Menya D, Naanyu V, Orango V, Pastakia SD, Valente TW, Hogan JW, Fuster V. Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya. J Am Coll Cardiol 2021; 77:2007-2018. [PMID: 33888251 PMCID: PMC8065205 DOI: 10.1016/j.jacc.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/12/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746).
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Affiliation(s)
- Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, New York, USA.
| | - Jemima H Kamano
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | | | - Eric A Finkelstein
- Duke University, Durham, North Carolina, USA; Duke-National University of Singapore Medical School, Singapore
| | - Carol R Horowitz
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Simon Manyara
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Diana Menya
- School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Tran DN, Were PM, Kangogo K, Amisi JA, Manji I, Pastakia SD, Vedanthan R. Supply-chain strategies for essential medicines in rural western Kenya during COVID-19. Bull World Health Organ 2021; 99:388-392. [PMID: 33958827 PMCID: PMC8061666 DOI: 10.2471/blt.20.271593] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
Problem The coronavirus disease 2019 (COVID-19) pandemic has disrupted health systems worldwide and threatened the supply of essential medicines. Especially affected are vulnerable patients in low- and middle-income countries who can only afford access to public health systems. Approach Soon after physical distancing and curfew orders began on 15 March 2020 in Kenya, we rapidly implemented three supply-chain strategies to ensure a continuous supply of essential medicines while minimizing patients’ COVID-19 exposure risks. We redistributed central stocks of medicines to peripheral health facilities to ensure local availability for several months. We equipped smaller, remote health facilities with medicine tackle boxes. We also made deliveries of medicines to patients with difficulty reaching facilities. Local setting Τo implement these strategies we leveraged our 30-year partnership with local health authorities in rural western Kenya and the existing revolving fund pharmacy scheme serving 85 peripheral health centres. Relevant changes In April 2020, stocks of essential chronic and non-chronic disease medicines redistributed to peripheral health facilities increased to 835 140 units, as compared with 316 330 units in April 2019. We provided medicine tackle boxes to an additional 46 health facilities. Our team successfully delivered medications to 264 out of 311 patients (84.9%) with noncommunicable diseases whom we were able to reach. Lessons learnt Our revolving fund pharmacy model has ensured that patients’ access to essential medicines has not been interrupted during the pandemic. Success was built on a community approach to extend pharmaceutical services, adapting our current supply-chain infrastructure and working quickly in partnership with local health authorities.
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Affiliation(s)
- Dan N Tran
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, United States of America (USA)
| | - Phelix M Were
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Kibet Kangogo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - James A Amisi
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Imran Manji
- Department of Pharmacy, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sonak D Pastakia
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 640 Eskenazi Ave, West Lafayette, IN 46202, USA
| | - Rajesh Vedanthan
- Department of Population Health, New York University Grossman School of Medicine, New York, USA
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16
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Miller ML, Schellhase E, Whicker H, Manji I, Karwa R, Pastakia SD, Kimani S. Global service learning: A unique educational pathway for community engagement and student scholarship development. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Monica L. Miller
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana USA
- Pharmacy Department, Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Ellen Schellhase
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana USA
- Pharmacy Department, Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Hadley Whicker
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana USA
| | - Imran Manji
- Department of Pharmacy, Moi Teaching and Referral Hospital Eldoret Kenya
| | - Rakhi Karwa
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana USA
- Pharmacy Department, Academic Model Providing Access to Healthcare Eldoret Kenya
- Department of Pharmacology and Toxicology, Moi University College of Health Sciences Eldoret Kenya
| | - Sonak D. Pastakia
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana USA
- Pharmacy Department, Academic Model Providing Access to Healthcare Eldoret Kenya
- Department of Pharmacology and Toxicology, Moi University College of Health Sciences Eldoret Kenya
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17
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Pastakia SD, Kosgei WK, Christoffersen-Deb A, Kiragu B, Hector JN, Anusu G, Saravanan P. Risk of Dysglycemia in Pregnancy amongst Kenyan Women with HIV Infection: A Nested Case-Control Analysis from the STRiDE Study. J Diabetes Res 2021; 2021:8830048. [PMID: 33880381 PMCID: PMC8046559 DOI: 10.1155/2021/8830048] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Gestational diabetes is a common complication, whose incidence is growing globally. There is a pressing need to obtain more data on GDM in low- and middle-income countries, especially amongst high-risk populations, as most of the data on GDM comes from high-income countries. With the growing awareness of the role HIV plays in the progression of noncommunicable diseases and the disproportionate HIV burden African countries like Kenya face, investigating the potential role HIV plays in increasing dysglycemia amongst pregnant women with HIV is an important area of study. METHODS The STRiDE study is one of the largest ever conducted studies of GDM in Kenya. This study enrolled pregnant women aged between 16 and 50 who were receiving care from public and private sector facilities in Eldoret, Kenya. Within this study, women received venous testing for glycosylated hemoglobin (HbA1c) and fasting glucose between 8- and 20-week gestational age. At their 24-32-week visit, they received a venous 75 g oral glucose tolerance test (OGTT). Because of the pressing need to assess the burden of GDM within the population of pregnant women with HIV, a nested case-control study design was used. Pregnant women with HIV within the larger STRiDE cohort were matched to non-HIV-infected women within the STRiDE cohort at a 1 : 3 ratio based on body mass index, parity, family history of GDM, gestational age, and family history of hypertension. The measurements of glucose from the initial visit (fasting glucose and HbA1c) and follow-up visit (OGTT) were compared between the two groups of HIV+ cases and matched HIV- controls. RESULTS A total of 83 pregnant women with HIV were well matched to 249 non-HIV-infected women from the STRiDE cohort with marital status being the only characteristic that was statistically significantly different between the two groups. Statistically significant differences were not observed in the proportion of women who developed GDM, the fasting glucose values, the HbA1c, or OGTT measurements between the two groups. Discussion. Significant associations were not seen between the different measures of glycemic status between pregnant women with and without HIV. While significant differences were not seen in this cohort, additional investigation is needed to better describe the association of dysglycemia with HIV, especially in Kenyan populations with a higher prevalence of GDM.
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Affiliation(s)
- Sonak D. Pastakia
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, 640 Eskenazi Ave, Indianapolis, IN 46202, USA
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Astrid Christoffersen-Deb
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Moi Teaching and Referral Hospital, AMPATH Plus-RMNCAH/FP, Kenya
- Department of Obstetrics and Gynaecology, University of British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Canada
| | - Benson Kiragu
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - John N. Hector
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Gertrude Anusu
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Ponnusamy Saravanan
- Division of Health Sciences, Warwick Medical School, University of Warwick, UK
- Academic Department of Diabetes & Endocrinology, George Eliot Hospital NHS Trust, Nuneaton, UK
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Chang AY, Mungai M, Coates SJ, Chao T, Odhiambo HP, Were PM, Fletcher SL, Maurer T, Karwa R, Pastakia SD. Implementing a Locally Made Low-Cost Intervention for Wound and Lymphedema Care in Western Kenya. Dermatol Clin 2021; 39:91-100. [PMID: 33228865 PMCID: PMC7686544 DOI: 10.1016/j.det.2020.08.009] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In Western Kenya, the burden of chronic wounds and lymphedema has a significant impact on functionality and quality of life. Major barriers to provision of care include availability, affordability, and accessibility of bandages. At the Academic Model Providing Access to Healthcare, dermatologists and pharmacists collaborated to develop a 2-component compression bandage modeled after the Unna boot, using locally available materials, that is distributed through a revolving fund pharmacy network. In partnership with nursing, use of these bandages at a national referral hospital and a few county facilities has increased, but increasing utilization to an expanded catchment area is needed.
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Affiliation(s)
- Aileen Y Chang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Dermatology, University of California, School of Medicine, P.O. Box 4606 Eldoret, Kenya 30100.
| | - Margaret Mungai
- Clinical Services, Moi Teaching & Referral Hospital, PO Box 3, Code 30100, Eldoret, Kenya
| | - Sarah J Coates
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Dermatology, University of California, San Francisco School of Medicine, 1701 Divisadero Street, Suite 4-20, San Francisco, CA 94143-0316, USA
| | - Tiffany Chao
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA 92617, USA
| | | | - Phelix M Were
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sara L Fletcher
- Drug Use Research and Management, Oregon State University College of Pharmacy, 2730 SW Moody Avenue, CL5CP, Portland, OR 97201, USA
| | - Toby Maurer
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 139, Indianapolis, IN 46202, USA
| | - Rakhi Karwa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN 46202-2879, USA
| | - Sonak D Pastakia
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN 46202-2879, USA
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Shaikh S, Ashraf H, Shaikh K, Iraqi H, Ndour Mbaye M, Kake A, Mohamed GA, Selim S, Wali Naseri M, Syed I, Said JAK, Raza SA, Kassim H, Aydin H, Latheef A, Beebeejaun M, Uloko AE, Pastakia SD, Kalra S. Diabetes Care During Hajj. Diabetes Ther 2020; 11:2829-2844. [PMID: 33063269 PMCID: PMC7561249 DOI: 10.1007/s13300-020-00944-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022] Open
Abstract
Diabetes mellitus affects over 463 million individuals worldwide. Religious activities such as the Hajj pilgrimage have a major impact on patients with diabetes mellitus, including increasing the risk of hyperglycaemia and hypoglycaemia. This increased risk is due to dietary changes and intense physical activity during pilgrimage while being on antidiabetic medications. Approximately 20% of the pilgrims with underlying illnesses who visit Mecca are diabetic, and complications, such as diabetic ketoacidosis, nonketotic hyperosmolar state, and fatigue/unconsciousness due to hypoglycaemia, have been observed among these patients. Diabetic patients are also at a high risk for foot complications and infections. To avoid any aggravation of the diabetes, a complete biochemical evaluation of the patient must be conducted before Hajj, and the patients must be provided contextualized educational guidance to avert these potential health challenges. This counselling should include the importance of carrying with them at all time their relevant medical history, summaries of the current treatment regimen and emergency snacks. In addition, to reduce the risk of hypoglycaemia, the dosage of insulin should be reduced in selected patients by 20% and that of sulfonylurea should be reduced as needed. Basal insulin and glucagon-like peptide 1 receptor agonists are associated with fewer complications and can be preferentially prescribed. Those patients with type 1 diabetes can continue with the use of insulin pump with suitable education prior to Hajj. For the prevention of foot problems, the use of padded socks and well-fitting shoes is recommended along with an insistence on not walking barefoot. After Hajj, the patient must be followed up, and necessary investigations must be made along with readjustment of insulin dosage in those patients for whom it was reduced. Until the pandemic situation abates, all diabetic patients should avoid making the Hajj journey.
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Affiliation(s)
| | - Hamid Ashraf
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, India
| | | | - Hinde Iraqi
- Service d'Endocrinologie et Maladies Métaboliques, Center Hospitalier Universaitaire Ibn Sina de Rabat, Rabat, Morocco
| | | | - Amadou Kake
- National Non-Communicable Diseases Coordinator, Ministry of Health, Conakry, Guinea
| | | | - Shahjada Selim
- Department of Endocrinology and Metabolism, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | | | - Imran Syed
- Victoria Hospital in Lusaka, Lusaka, Zambia
| | | | - S Abbas Raza
- Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Hidayat Kassim
- Provincial Directorate of Health, Ministry of Public Health, Maputo, Mozambique
| | - Hasan Aydin
- Yeditepe University Hospital, Istanbul, Turkey
| | - Ali Latheef
- Department of Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | - Andrew E Uloko
- Aminu Kano Teaching Hospital-Bayero University Kano, Kano, Nigeria
| | - Sonak D Pastakia
- Indiana University-Kenya Partnership, Purdue University, West Lafayette, IN, USA
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20
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Osetinsky B, Hontelez JAC, Lurie MN, McGarvey ST, Bloomfield GS, Pastakia SD, Wamai R, Bärnighausen T, de Vlas SJ, Galárraga O. Epidemiological And Health Systems Implications Of Evolving HIV And Hypertension In South Africa And Kenya. Health Aff (Millwood) 2020; 38:1173-1181. [PMID: 31260360 DOI: 10.1377/hlthaff.2018.05287] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health systems in sub-Saharan Africa are facing an ongoing HIV epidemic and increasing burden of noncommunicable disease. With the focus shifting to the development of comprehensive primary health care and chronic disease treatment, multidisease modeling is integral to estimating future health care needs. We extended an established agent-based model of HIV transmission to include hypertension in two rural settings: KwaZulu-Natal, South Africa, and western Kenya. We estimated that from 2018 to 2028 hypertension prevalence would increase from 40 percent to 46 percent in KwaZulu-Natal and from 29 percent to 35 percent in western Kenya, while HIV prevalence is stabilizing and predicted to decrease. As the health system burden in sub-Saharan Africa is changing, innovative chronic disease treatment and the broadening of successful programs, such as integrated HIV and noncommunicable disease care, are necessary to reach universal health care coverage.
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Affiliation(s)
- Brianna Osetinsky
- Brianna Osetinsky is a PhD candidate in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, in Providence, Rhode Island
| | - Jan A C Hontelez
- Jan A. C. Hontelez is an assistant professor in the Department of Public Health at Erasmus MC, Erasmus University Rotterdam, in the Netherlands, and at the Heidelberg Institute of Global Health, Heidelberg University, in Germany
| | - Mark N Lurie
- Mark N. Lurie is an associate professor in the Department of Epidemiology, Brown University School of Public Health
| | - Stephen T McGarvey
- Stephen T. McGarvey is director of the International Health Institute and a professor in the Department of Epidemiology, both at the Brown University School of Public Health
| | - Gerald S Bloomfield
- Gerald S. Bloomfield is an associate professor in the Department of Medicine and Global Health, Duke University School of Medicine, in Durham, North Carolina
| | - Sonak D Pastakia
- Sonak D. Pastakia is a professor of pharmacy practice with the Purdue Kenya Partnership, Purdue University College of Pharmacy, in Eldoret, Kenya
| | - Richard Wamai
- Richard Wamai is an associate professor in the Department of Cultures, Societies, and Global Studies, Northeastern University, in Boston, Massachusetts
| | - Till Bärnighausen
- Till Bärnighausen is the Alexander von Humboldt University Professor and director of the Heidelberg Institute of Global Health, Heidelberg University. He is also senior faculty at the Africa Health Research Institute, in Somkhele, South Africa, and an adjunct professor of global health at the Harvard T. H. Chan School of Public Health, in Boston
| | - Sake J de Vlas
- Sake J. de Vlas is a professor in the Department of Public Health at Erasmus MC, Erasmus University Rotterdam
| | - Omar Galárraga
- Omar Galárraga ( ) is an associate professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health
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Karwa R, Miller ML, Schellhase E, Tran D, Manji I, Njuguna B, Fletcher S, Kanyi J, Maina M, Jakait B, Kigen G, Kipyegon V, Aruasa W, Crowe S, Pastakia SD. Evaluating the impact of a 15‐year academic partnership to promote sustainable engagement, education, and scholarship in global health. J Am Coll Clin Pharm 2020. [DOI: 10.1002/jac5.1249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Rakhi Karwa
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Monica L. Miller
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Ellen Schellhase
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Dan Tran
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Imran Manji
- Moi Teaching and Referral Hospital Eldoret Kenya
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | | | - Sara Fletcher
- Department of Drug Use Research and Management, Oregon State University College of Pharmacy Corvallis Oregon USA
| | - John Kanyi
- Moi Teaching and Referral Hospital Eldoret Kenya
| | - Mercy Maina
- Moi Teaching and Referral Hospital Eldoret Kenya
| | | | - Gabriel Kigen
- Department of Pharmacology & Therapeutics, Moi University College of Health Sciences Eldoret Kenya
| | | | - Wilson Aruasa
- Moi Teaching and Referral Hospital Eldoret Kenya
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Susie Crowe
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy East Tennessee State University Johnson Tennessee USA
| | - Sonak D. Pastakia
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
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22
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Pastakia SD. Past, present, and future journeys in clinical pharmacy around the world. J Am Coll Clin Pharm 2020. [DOI: 10.1002/jac5.1282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sonak D. Pastakia
- College of Pharmacy, Center for Health Equity and Innovation Purdue University Indianapolis Indiana USA
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23
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Pastakia SD, Tran DN, Manji I, Schellhase E, Karwa R, Miller ML, Aruasa W, Khan ZM. Framework and case study for establishing impactful global health programs through academia - biopharmaceutical industry partnerships. Res Social Adm Pharm 2020; 16:1519-1525. [PMID: 32792324 DOI: 10.1016/j.sapharm.2020.07.018] [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] [Received: 02/18/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The field of global health has grown with multiple different public and private stakeholders engaging in the effort to improve health outcomes for underserved populations around the world. There is, however, only limited published guidance on how to promote successful partnerships between academia and the biopharmaceutical industry. OBJECTIVE This analysis will provide a framework for developing successful partnerships around five central principles. This framework will then be applied to two representative pharmacy collaboration case studies focused on training and donations. FRAMEWORK DESCRIPTION AND CASE STUDY FINDINGS Within the Academic Model Providing Access to Healthcare (AMPATH), successful collaborations between the biopharmaceutical industry philanthropic entities and academic partners have consistently prioritized 1) contextualization, 2) collaboration, 3) local priorities, 4) institutional commitment, and 5) integration. In the first case study, the application of this framework to clinical pharmacy training activities sponsored by Celgene and implemented by the Purdue Kenya Partnership has helped the program transition from an entirely donor dependent training program to a revenue generating, locally administered program which is now recognized and accredited by the Kenyan government. In the second case study, medication donations from Eli Lilly and Company have been converted from a traditional donation program in one Kenyan health facility to a replicable and sustainable supply chain model which has been expanded to more than 70 public sector facilities across western Kenya. CONCLUSION Adherence to the five core principles of the proposed framework can help guide partnerships between academic institutions and the biopharmaceutical industry to advance healthcare services for underserved populations around the world. As large-scale government-based development agencies continue to primarily focus on specific disease states, biopharmaceutical industry-based collaborations can help initiate activities in underfunded therapeutic areas such as non-communicable diseases.
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Affiliation(s)
- Sonak D Pastakia
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya.
| | - Dan N Tran
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Imran Manji
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Ellen Schellhase
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Rakhi Karwa
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Monica L Miller
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Zeba M Khan
- Celgene (Now Part of Bristol Myers Squibb), USA
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Akwanalo C, Njuguna B, Mercer T, Pastakia SD, Mwangi A, Dick J, Dickhaus J, Andesia J, Bloomfield GS, Valente T, Kibachio J, Pillsbury M, Pathak S, Thakkar A, Vedanthan R, Kamano J, Naanyu V. Strategies for Effective Stakeholder Engagement in Strengthening Referral Networks for Management of Hypertension Across Health Systems in Kenya. Glob Heart 2020; 14:173-179. [PMID: 31324372 DOI: 10.1016/j.gheart.2019.06.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Ineffective referral networks in low- and middle-income countries hinders access to evidence-based therapies by hypertensive patients, leading to high cardiovascular mortality and morbidity. The STRENGTHS (Strengthening Referral Networks for Management of Hypertension Across Health Systems) study evaluates strategies to improve referral processes utilizing the International Association of Public Participation framework to engage stakeholders. OBJECTIVES This study sought to identify and engage key stakeholders involved in referral of patients in the Ministry of Health, western Kenya. METHODS Key stakeholders involved in policy formulation, provision, or consumption of public health care service were mapped out and contacted by phone, letters, and emissaries to schedule meetings, explain research objectives, and obtain feedback. RESULTS Key stakeholders identified were the Ministry of Health, the Academic Model Providing Access to Healthcare, health professionals, communities and their leadership, and patients. Engaging them resulted in permission to contact research in their areas of jurisdiction and enabled collaboration in updating care protocols with emphasis on timely and appropriate referrals. CONCLUSIONS Early stakeholder identification and engagement using the International Association of Public Participation model eased explanation of research objectives, building consensus, and shaping the interventions to improve the referral process.
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Affiliation(s)
- Constantine Akwanalo
- College of Health Sciences, Moi University, Eldoret, Kenya; Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | | | - Tim Mercer
- Department of Population Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Sonak D Pastakia
- College of Health Sciences, Moi University, Eldoret, Kenya; College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Ann Mwangi
- College of Health Sciences, Moi University, Eldoret, Kenya
| | | | - Julia Dickhaus
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | | | | | | | - Joseph Kibachio
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Max Pillsbury
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Jemima Kamano
- College of Health Sciences, Moi University, Eldoret, Kenya; Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Violet Naanyu
- College of Health Sciences, Moi University, Eldoret, Kenya
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Thakkar A, Valente T, Andesia J, Njuguna B, Miheso J, Mercer T, Mwangi E, Pastakia SD, Pillsbury MM, Pathak S, Kamano J, Naanyu V, Vedanthan R, Bloomfield GS, Akwanalo C. P6371Network characteristics of a hypertension referral system in western kenya. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
The Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) trial is creating and testing interventions to improve the effectiveness of referral networks for patients with hypertension in Western Kenya.
Purpose
Network analysis of facility-based healthcare providers was used to understand the existing network of referrals. The ultimate goal was to identify both structural gaps and opportunities for implementation of the planned intervention.
Methods
A network survey was administered to providers who deliver care to patients with hypertension asking individuals to nominate a) individuals to whom, and b) facilities to which they refer patients, both up and down the health system. We analyzed survey data using centrality measures of in-degree and out-degree (number of links each provider received and sent, respectively), as well as fitting a core-periphery (CP) model. A higher CP indicates a strong referral network, while a lower CP indicates a relatively weaker network.
Results
Data were collected from 130 providers across 39 sites within 7 geographically separate network clusters. Each cluster consists of a mix of primary, secondary, and/or tertiary facilities. Compared to a perfect CP referral network model (Correlation Score [CP] = 1.00) and a random referral network model (CP = 0.200), the provider referral networks within each cluster showed a weak tendency for CP structure. There was a large range in CP from 0.334 to 0.639. In contrast, cluster-level facility networks showed a strong tendency for CP structure, with a CP range of 0.857 to 0.949.
Core Periphery Correlation Scores [CP] Network Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7 Provider Referrals 0.433 0.424 0.334 0.639 0.535 0.448 0.407 Facility Referrals 0.949 0.894 0.871 0.949 0.949 0.904 0.857 Each cluster represents a geographically separate referral network. A random referral network would reveal a CP score of 0.200; while a perfect referral network would give a CP of 1.00.
Referral Network Models
Conclusions
The current health system across Western Kenya does not demonstrate a strong network of referrals between providers for patients with hypertension. While facility-to-facility referrals are more in-line with a perfect referral model, there are gaps in communication between the specific providers. These results highlight the need for STRENGTHS to design and test interventions that strengthen provider referral patterns in order to improve blood pressure control and reduce cardiovascular risk.
Acknowledgement/Funding
National Institutes of Health: National Heart Lung and Blood Institute, Doris Duke Charitable Foundation:International Clinical Research Fellowship
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Affiliation(s)
- A Thakkar
- Duke University School of Medicine, Durham, United States of America
| | - T Valente
- University of Southern California, Los Angeles, United States of America
| | - J Andesia
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - B Njuguna
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - J Miheso
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - T Mercer
- University of Texas at Austin, Austin, United States of America
| | - E Mwangi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - S D Pastakia
- Purdue University, College of Pharmacy, West Lafayette, United States of America
| | - M M Pillsbury
- University of California San Francisco, School of Medicine, San Francisco, United States of America
| | - S Pathak
- Mount Sinai School of Medicine, New York, United States of America
| | - J Kamano
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - R Vedanthan
- New York University Langone Medical Center, New York, United States of America
| | - G S Bloomfield
- Duke University School of Medicine, Durham, United States of America
| | - C Akwanalo
- Moi Teaching and Referral Hospital, Eldoret, Kenya
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Mercer T, Njuguna B, Bloomfield GS, Dick J, Finkelstein E, Kamano J, Mwangi A, Naanyu V, Pastakia SD, Valente TW, Vedanthan R, Akwanalo C. Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) in western Kenya: a study protocol of a cluster randomized trial. Trials 2019; 20:554. [PMID: 31500661 PMCID: PMC6734355 DOI: 10.1186/s13063-019-3661-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/14/2019] [Indexed: 11/20/2022] Open
Abstract
Background Hypertension is a major risk factor for cardiovascular disease (CVD), yet treatment and control rates for hypertension are very low in low- and middle-income countries (LMICs). Lack of effective referral networks between different levels of the health system is one factor that threatens the ability to achieve adequate blood pressure control and prevent CVD-related morbidity. Health information technology and peer support are two strategies that have improved care coordination and clinical outcomes for other disease entities in other settings; however, their effectiveness and cost-effectiveness in strengthening referral networks to improve blood pressure control and reduce CVD risk in low-resource settings are unknown. Methods/design We will use the PRECEDE-PROCEED framework to conduct transdisciplinary implementation research, focused on strengthening referral networks for hypertension in western Kenya. We will conduct a baseline needs and contextual assessment using a mixed-methods approach, in order to inform a participatory, community-based design process to fully develop a contextually and culturally appropriate intervention model that combines health information technology and peer support. Subsequently, we will conduct a two-arm cluster randomized trial comparing 1) usual care for referrals vs 2) referral networks strengthened with our intervention. The primary outcome will be one-year change in systolic blood pressure. The key secondary clinical outcome will be CVD risk reduction, and the key secondary implementation outcomes will include referral process metrics such as referral appropriateness and completion rates. We will conduct a mediation analysis to evaluate the influence of changes in referral network characteristics on intervention outcomes, a moderation analysis to evaluate the influence of baseline referral network characteristics on the effectiveness of the intervention, as well as a process evaluation using the Saunders framework. Finally, we will analyze the incremental cost-effectiveness of the intervention relative to usual care, in terms of costs per unit decrease in systolic blood pressure, per percentage change in CVD risk score, and per disability-adjusted life year saved. Discussion This study will provide evidence for the implementation of innovative strategies for strengthening referral networks to improve hypertension control in LMICs. If effective, it has the potential to be a scalable model for health systems strengthening in other low-resource settings worldwide. Trial registration Clinicaltrials.gov, NCT03543787. Registered on 29 June 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3661-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tim Mercer
- The University of Texas at Austin Dell Medical School, 1701 Trinity St., Austin, TX, 78712, USA
| | - Benson Njuguna
- Moi Teaching and Referral Hospital, PO Box 3-30100, Eldoret, Kenya
| | - Gerald S Bloomfield
- Duke University School of Medicine, Duke Clinical Research Institute and Duke Global Health Institute, 2301 Erwin Rd., Durham, NC, 27704, USA
| | - Jonathan Dick
- Indiana University School of Medicine, 535 Barnhill Dr., Indianapolis, IN, 46202, USA
| | - Eric Finkelstein
- Duke-NUS Medical School, Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Jemima Kamano
- Moi University School of Medicine, PO Box 4606, Eldoret, 30100, Kenya
| | - Ann Mwangi
- Moi University School of Medicine, PO Box 4606, Eldoret, 30100, Kenya
| | - Violet Naanyu
- Moi University School of Medicine, PO Box 4606, Eldoret, 30100, Kenya
| | - Sonak D Pastakia
- Purdue University College of Pharmacy, 575 Stadium Mall Dr., West Lafayette, IN, 47907, USA
| | - Thomas W Valente
- Keck School of Medicine University of Southern California, 2001 N Soto Street, Soto Street Building, Suite 330, MC 9239, Los Angeles, CA, 90089-9239, USA
| | - Rajesh Vedanthan
- New York University School of Medicine, 180 Madison Avenue, 8th Floor, New York, NY, 10016, USA
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Nkinda L, Patel K, Njuguna B, Ngangali JP, Memiah P, Bwire GM, Majigo MV, Mizinduko M, Pastakia SD, Lyamuya E. C - reactive protein and interleukin - 6 levels among human immunodeficiency virus -infected patients with dysglycemia in Tanzania. BMC Endocr Disord 2019; 19:77. [PMID: 31331321 PMCID: PMC6647154 DOI: 10.1186/s12902-019-0407-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/11/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Chronic inflammation has been associated with dysglycemia among people living with HIV (PLHIV). There is however, limited data regarding this phenomenon in sub-Sahara Africa (SSA). Therefore we assessed the levels of C-reactive protein (CRP) and Interleukin 6 (IL-6) on a cohort of PLHIV and its associations with dysglycemia in Tanzania. METHODS We conducted a cross-sectional study at the Infectious Disease Clinic (IDC) in Tanzania from March to May 2018. Purposive sampling was used to identify participants who had an undetectable viral load, were on 1st line anti-retroviral therapy (ART) and had an overnight fast. The WHO stepwise approach for non-communicable disease (NCD) surveillance was used to collect data. Fasting blood glucose and blood glucose after 75 g oral glucose load was measured, and Enzyme-linked immunosorbent assay (ELISA) was used to test for inflammatory markers (IL-6 and CRP). Associations were explored using the Chi square test and binary logistic regression was performed to estimate the odds ratios. A p-value less than 0.05 was considered statistically significant. RESULTS A total of 240 participants were enrolled. Forty two percent were overweight/obese (> 25 kg/m2), 89% had a high waist to height ratio. The median ART duration was 8(5-10) years. The prevalence of dysglycemia among our cohort of PLHIV was 32%. High CRP was associated with a 2.05 increased odds of having dysglycemia OR 2.05 (1.15-3.65) (p = 0.01). Taking stavudine was associated with a 1.99 odds of having dysglycemia OR 1.99 (1.04-3.82) (p = 0.03).We did not find a significant association between IL-6 and dysglycemia. CONCLUSION High CRP and taking stavudine were significantly associated with dysglycemia among PLHIV with undetectable viral load.
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Affiliation(s)
- Lilian Nkinda
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O box 65001, Dares Salaam, Tanzania
- Department of Immunology, Moi University, P.O. Box 4606-30100, Eldoret, Kenya
| | - Kirtika Patel
- Department of Immunology, Moi University, P.O. Box 4606-30100, Eldoret, Kenya
| | - Benson Njuguna
- Department of Pharmacy and Department of Cardiology, Moi Teaching and Referral Hospital, P.O Box 3-30100, Eldoret, Kenya
| | - Jean Pierre Ngangali
- Department of Immunology, Moi University, P.O. Box 4606-30100, Eldoret, Kenya
- Rwanda National Reference Laboratory, P.O Box 4668, Kigali, Rwanda
| | - Peter Memiah
- Department of Public Health, University of West Florida, 11000 University Parkway, Pensacola, USA
| | - George M. Bwire
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O box 65001, Dares Salaam, Tanzania
| | - Mtebe V. Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O box 65001, Dares Salaam, Tanzania
| | - Mucho Mizinduko
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dares Salaam, Tanzania
| | - Sonak D. Pastakia
- Purdue College of Pharmacy, Purdue Kenya Partnership, P.O Box 5760, Eldoret, Kenya
| | - Eligius Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O box 65001, Dares Salaam, Tanzania
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von Oettingen JE, Ginsburg O, Kishore SP, Pastakia SD, Schroeder LF, Milner DA, Vedanthan R. The AEIOU of essential diagnostics: align, expand, implement, oversee, and update. Lancet Glob Health 2019; 7:e694-e695. [PMID: 31097269 DOI: 10.1016/s2214-109x(19)30039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 01/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Julia E von Oettingen
- Montreal Children's Hospital, Montreal, QC H4A 3J1, Canada; Research Institute, McGill University Health Centre, Montreal, QC, Canada.
| | - Ophira Ginsburg
- Department of Population Health, New York University Langone Health, New York, NY, USA
| | | | | | - Lee F Schroeder
- Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Dan A Milner
- American Society for Clinical Pathology, Chicago, IL, USA
| | - Rajesh Vedanthan
- Department of Population Health, New York University Langone Health, New York, NY, USA
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Hurst JR, Dickhaus J, Maulik PK, Miranda JJ, Pastakia SD, Soriano JB, Siddharthan T, Vedanthan R. Global Alliance for Chronic Disease researchers' statement on multimorbidity. Lancet Glob Health 2019; 6:e1270-e1271. [PMID: 30420026 DOI: 10.1016/s2214-109x(18)30391-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/10/2018] [Indexed: 10/27/2022]
Affiliation(s)
- John R Hurst
- UCL Respiratory, University College London, London, UK.
| | - Julia Dickhaus
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Pallab K Maulik
- Research, The George Institute of Global Health, New Delhi, India; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, NSW, Australia; Nuffield Department for Women and Reproductive Health, The George Institute of Global Health, University of Oxford, Oxford, UK
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sonak D Pastakia
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianopolis, Indiana, IN, USA
| | - Joan B Soriano
- Department of Pneumology, Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Pastakia SD, Nuche-Berenguer B, Pekny CR, Njuguna B, O’Hara EG, Cheng SY, Laktabai J, Buckwalter V, Kirui N, Chege P. Retrospective assessment of the quality of diabetes care in a rural diabetes clinic in Western Kenya. BMC Endocr Disord 2018; 18:97. [PMID: 30591044 PMCID: PMC6307239 DOI: 10.1186/s12902-018-0324-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa continues to face the highest rate of mortality from diabetes in the world due to limited access to quality diabetes care. We assessed the quality of diabetes care in a rural diabetes clinic in western Kenya. METHODS To provide a comprehensive assessment, a set of clinical outcomes, process, and structure metrics were evaluated to assess the quality of diabetes care provided in the outpatient clinic at Webuye District Hospital. The primary clinical outcome measures were the change in HbA1c and point of care blood glucose. In assessing process metrics, the primary measure was the percentage of patients who were lost to follow up. The structure metrics were assessed by evaluating different facets of the operation of the clinic and their accordance with the International Diabetes Federation (IDF) guidelines. RESULTS A total of 524 patients were enrolled into the diabetes clinic during the predefined period of evaluation. The overall clinic population demonstrated a statistically significant reduction in HbA1c and point of care blood glucose at all time points of evaluation after baseline. Patients had a mean baseline HbA1C of 10.2% which decreased to 8.4% amongst the patients who remained in care after 18 months. In terms of process measures, 38 patients (7.3%) were characterized as being lost to follow up as they missed clinic visits for more than 6 months. Through the assessment of structural metrics, the clinic met at least the minimal standards of care for 14 out of the 19 domains recommended by the IDF. CONCLUSION This analysis illustrates the gains made in various elements of diabetes care quality which can be used by other programs to guide diabetes care scale up across the region.
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Affiliation(s)
- Sonak D. Pastakia
- Moi University School of Medicine, Nandi Hills Road, Eldoret, 30100 Kenya
- USAID-Academic Model Providing Access to Healthcare (AMPATH) /Moi Teaching and Referral Hospital, Nandi Hills Road, Eldoret, 30100 Kenya
- Purdue Kenya Partnership, Purdue University College of Pharmacy, PO Box 5760, Eldoret, 30100 Kenya
- Webuye District Hospital, PO Box 25, Webuye Road, Webuye, 50205 Kenya
| | - Bernardo Nuche-Berenguer
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 31 Center Dr, Bethesda, MD 20892 USA
| | - Chelsea Regina Pekny
- Ohio State University, College of Pharmacy, 500 W 12th Ave, Parks Hall, Columbus, OH 43210 USA
| | - Benson Njuguna
- USAID-Academic Model Providing Access to Healthcare (AMPATH) /Moi Teaching and Referral Hospital, Nandi Hills Road, Eldoret, 30100 Kenya
| | | | - Stephanie Y. Cheng
- Purdue Kenya Partnership, Purdue University College of Pharmacy, PO Box 5760, Eldoret, 30100 Kenya
| | - Jeremiah Laktabai
- Moi University School of Medicine, Nandi Hills Road, Eldoret, 30100 Kenya
- USAID-Academic Model Providing Access to Healthcare (AMPATH) /Moi Teaching and Referral Hospital, Nandi Hills Road, Eldoret, 30100 Kenya
- Webuye District Hospital, PO Box 25, Webuye Road, Webuye, 50205 Kenya
| | - Victor Buckwalter
- Webuye District Hospital, PO Box 25, Webuye Road, Webuye, 50205 Kenya
| | - Nicholas Kirui
- USAID-Academic Model Providing Access to Healthcare (AMPATH) /Moi Teaching and Referral Hospital, Nandi Hills Road, Eldoret, 30100 Kenya
| | - Patrick Chege
- Moi University School of Medicine, Nandi Hills Road, Eldoret, 30100 Kenya
- Webuye District Hospital, PO Box 25, Webuye Road, Webuye, 50205 Kenya
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Bernard C, Pekny C, Omukagah CO, Bernard CO, Manji I, Pastakia SD, Christoffersen-Deb A. Integration of contraceptive services into anticoagulation management services improves access to long-acting reversible contraception. Contraception 2018; 98:486-491. [PMID: 30076833 PMCID: PMC6941485 DOI: 10.1016/j.contraception.2018.07.139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/22/2018] [Accepted: 07/29/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Integration of services is a promising way to improve access to contraception in sub-Saharan Africa, but few studies have evaluated this strategy to increase access to contraception among women requiring anticoagulation. Our objective was to evaluate a model of care integrating contraceptive counseling and provision within an anticoagulation management clinic in Eldoret, Kenya, to determine the impact on long-acting reversible contraception (LARC) use. STUDY DESIGN We performed a prospective observational study of reproductive-age women referred for integrated services from the anticoagulation management clinic at Moi Teaching and Referral Hospital from March 2015 to March 2016. All participants received disease-specific contraceptive counseling and provision, free reversible methods (excluding hormonal intrauterine devices [IUDs]) and follow-up care. We compared LARC use 3 months postintervention to preintervention using the proportions test. Logistic regression analysis was used to determine factors related to use of contraceptive implants and copper IUDs. RESULTS Of 190 participants, 171 (90%) completed 3-month follow-up. There was a significant increase in contraceptive implant use from 10% to 19%, p=.02, and injectable contraceptive use from 14% to 24%, p=.013. There was a concomitant decrease in the use of no method/abstinence from 57% to 39% (33% decrease, p<.001). Younger age, having at least one child and discussing family planning with a partner were predictive of LARC use. CONCLUSION Integrating contraceptive services into an anticoagulation management clinic increases the use of highly effective contraception for women with cardiovascular disease. Implementation of similar models of care should be evaluated within other sites for chronic disease management. IMPLICATIONS A model of care integrating contraceptive counseling and provision into anticoagulation management services is an effective strategy to improve LARC and overall highly effective contraceptive use among women with cardiovascular disease requiring anticoagulation. This model of care may be utilized to prevent maternal morbidity and mortality among this high-risk population.
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Affiliation(s)
- Caitlin Bernard
- AMPATH/Indiana University, P.O. Box 4606, Eldoret, Kenya, 30100.
| | - Chelsea Pekny
- AMPATH/Purdue University, P.O. Box 4606, Eldoret, Kenya, 30100.
| | | | | | - Imran Manji
- AMPATH/Moi Teaching & Referral Hospital, P.O. Box 4606, Eldoret, Kenya, 30100.
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Chang AY, Karwa R, Busakhala N, Fletcher SL, Tonui EC, Wasike P, Kohn MA, Asirwa FC, Kiprono SK, Maurer T, Goodrich S, Pastakia SD. Randomized controlled trial to evaluate locally sourced two-component compression bandages for HIV-associated Kaposi sarcoma leg lymphedema in western Kenya: The Kenyan Improvised Compression for Kaposi Sarcoma (KICKS) study protocol. Contemp Clin Trials Commun 2018; 12:116-122. [PMID: 30402565 PMCID: PMC6205322 DOI: 10.1016/j.conctc.2018.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/05/2018] [Revised: 09/26/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background HIV-associated Kaposi sarcoma (KS), among the most frequent cancers seen in sub-Saharan Africa, is associated with a high prevalence of lymphedema. Lymphedema causes progressive functional impairment marked by swelling, physical discomfort, disfiguring changes, skin hardening from fibrosis, poor wound healing, and recurrent skin infection. While compression therapy is considered a major component of lymphedema management, this intervention has never been evaluated in HIV-associated KS lymphedema. Methods/design The Kenyan Improvised Compression for Kaposi Sarcoma (KICKS) study is a randomized, controlled trial. Due to variable lymphedema stage, we will use block randomization with a 1:1 allocation to assign participants to one of two groups: “Immediate compression” or “Delayed compression.” Those randomized to “Immediate compression” intervention arm will receive weekly two-component compression bandages while receiving chemotherapy, whereas those in the “Delayed compression” control arm will be followed during chemotherapy and then receive compression after chemotherapy is completed. The primary outcome is change in Lower Extremity Lymphedema Index from enrollment at Week 0 to blinded outcome assessment at Week 14 between intervention and control arms. Secondary outcomes are change in leg lymphedema-specific quality of life (LYMQOL) and change in overall health quality of life in cancer (EORTC QLQ C30). Discussion This represents the first study in sub-Saharan Africa to assess a lymphedema-directed intervention for KS, and the intervention—locally sourced two-component compression bandages—is affordable and available. Thus, the KICKS study is an important step towards developing an evidence-based path for regionally relevant management of HIV-associated KS lymphedema. Trial registration This trial was registered at ClinicalTrials.gov on January 19, 2018: identifier NCT03404297.
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Affiliation(s)
- Aileen Y. Chang
- University of California, San Francisco School of Medicine, Department of Dermatology, United States
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Corresponding author. University of California San Francisco, Department of Dermatology, San Francisco General Hospital, 1001 Potrero, Building 90, Ward 92, San Francisco, CA 94110, United States.
| | - Rakhi Karwa
- Purdue University School of Pharmacy, Department of Pharmacy Practice, United States
- Moi University School of Medicine, Department of Pharmacology, Kenya
| | - Naftali Busakhala
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Moi University School of Medicine, Department of Pharmacology, Kenya
| | - Sara L. Fletcher
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, United States
| | - Edith C. Tonui
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
| | - Paul Wasike
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Moi University School of Medicine, Department of Pharmacology, Kenya
| | - Michael A. Kohn
- University of California, San Francisco School of Medicine, Department of Epidemiology and Biostatistics, United States
| | - Fredrick Chite Asirwa
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Indiana University School of Medicine, Department of Hematology/Oncology, United States
| | - Samson K. Kiprono
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Moi University School of Medicine, Department of Medicine, Kenya
| | - Toby Maurer
- University of California, San Francisco School of Medicine, Department of Dermatology, United States
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
| | - Suzanne Goodrich
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Indiana University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States
| | - Sonak D. Pastakia
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, United States
- Moi University School of Medicine, Department of Pharmacology, Kenya
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Pastakia SD, Tran DN, Manji I, Wells C, Kinderknecht K, Ferris R. Building reliable supply chains for noncommunicable disease commodities: lessons learned from HIV and evidence needs. AIDS 2018; 32 Suppl 1:S55-S61. [PMID: 29952791 DOI: 10.1097/qad.0000000000001878] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Successful noncommunicable disease (NCD) management requires a reliable supply chain. The objectives of this article are to examine lessons learned from HIV supply chain initiatives, describe opportunities to advance supply chain systems for NCD health commodities based on HIV supply chain successes and identify areas where additional research is still needed for reliable NCD supply chains in LMICs. DESIGN We describe practical experiences gained from developing HIV supply chain systems and how those lessons can be used to inform NCD supply chain systems. METHODS Supply chain challenges with HIV commodities in low and middle-income countries (LMICs) are identified and categorized using literature review and expert experiences. Solutions are described on the basis of lessons learned from global HIV initiatives. Opportunities to further advance NCD supply chain systems are recommended. RESULTS Supply chain challenges can be organized into two groups: 1) resource mobilization and 2) resource utilization. Global HIV initiatives have responded to resource mobilization challenges by increasing availability of funding, filling human resource gaps, improving essential storage and creating better transport mechanisms and information technology infrastructure. These initiatives have assisted in better resource utilization by strengthening procurement processes, standardizing and simplifying supply chain systems, reducing integrity and security vulnerabilities and harnessing the power of better data. Advances achieved through HIV initiatives are readily transferrable to NCD supply chains with minimal additional investment. Research opportunities exist to identify the most efficient and cost-effective ways to develop more reliable supply chains for NCDs.
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Njuguna B, Vorkoper S, Patel P, Reid MJ, Vedanthan R, Pfaff C, Park PH, Fischer L, Laktabai J, Pastakia SD. Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: lessons learned and evidence gaps. AIDS 2018; 32 Suppl 1:S33-S42. [PMID: 29952788 PMCID: PMC6779053 DOI: 10.1097/qad.0000000000001887] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe available models of HIV and noncommunicable disease (NCD) care integration in sub-Saharan Africa (SSA). DESIGN Narrative review of published articles describing various models of HIV and NCD care integration in SSA. RESULTS We identified five models of care integration across various SSA countries. These were integrated community-based screening for HIV and NCDs in the general population; screening for NCDs and NCD risk factors among HIV patients enrolled in care; integration of HIV and NCD care within clinics; differentiated care for patients with HIV and/or NCDs; and population healthcare for all. We illustrated these models with descriptive case studies highlighting the lessons learned and evidence gaps from the various models. CONCLUSION Leveraging existing HIV infrastructure for NCD care is feasible with various approaches possible depending on available program capacity. Process and clinical outcomes for existing models of care integration are not yet described but are urgently required to further advise policy decisions on HIV/NCD care integration.
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Affiliation(s)
- Benson Njuguna
- Department of Pharmacy, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Pragna Patel
- Centers for Disease Control and Prevention, Center of Global Health, Division of Global HIV and TB, Atlanta, Georgia
| | - Mike J.A. Reid
- Institute for Global Health Delivery & Diplomacy, Global Health Sciences, UCSF & Divisions of HIV, Infectious Diseases and Global Health, UCSF, San Francisco, California
| | - Rajesh Vedanthan
- Department of Medicine, Department of Population Health Science and Policy, and Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Colin Pfaff
- Department of Family Medicine, College of Medicine, Dignitas International, Zomba, Malawi
| | - Paul H. Park
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lydia Fischer
- Department of Pediatrics and Psychiatry, Indiana University, Bloomington, Indiana, USA
| | - Jeremiah Laktabai
- Department of Family Medicine, College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya
| | - Sonak D. Pastakia
- Department of Family Medicine, Purdue University College of Pharmacy, West Lafayette, Indiana, USA
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Park PH, Pastakia SD. Access to Hemoglobin A1c in Rural Africa: A Difficult Reality with Severe Consequences. J Diabetes Res 2018; 2018:6093595. [PMID: 29682580 PMCID: PMC5846364 DOI: 10.1155/2018/6093595] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/25/2017] [Accepted: 12/27/2017] [Indexed: 12/23/2022] Open
Abstract
Sub-Saharan Africa (SSA) continues to have the highest diabetes-related mortality rate in the world. While there exists a multitude of health system barriers driving poor diabetes control, rural facilities particularly in SSA lack access to proper monitoring of glucose and other key biologic tests. At best, most of these diabetes patients receive random blood sugar readings only on the day of their clinic visit. This approach has very limited clinical value in determining dosage adjustments for narrow therapeutic index medications such as insulin. Furthermore, access to other blood tests and physical exam tools for detecting early signs of diabetes complications is limited. We propose that routine access to hemoglobin A1c (HbA1c) testing would not only allow for close monitoring of diabetes control but also provide critical data informing the population level risk for diabetes complications. However, implementing HbA1c testing does have its own barriers at rural facilities, including high costs, refrigeration requirements, and perceived discordance between HbA1c values and mean blood glucose levels for SSA patients. Fortunately, several pilots in rural SSA have illustrated feasibility of HbA1c testing. Further political will, price reduction, and context-specific research are needed. Increasing access to HbA1c testing is a critical step to combat the high diabetes-related mortality rates in rural SSA.
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Affiliation(s)
- Paul H. Park
- Inshuti Mu Buzima/Partners In Health-Rwanda, PO Box 3432, Kigali, Rwanda
| | - Sonak D. Pastakia
- Purdue Kenya Partnership, Purdue University College of Pharmacy, PO Box 5760, Eldoret 30100, Kenya
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Njuguna B, Kiplagat J, Bloomfield GS, Pastakia SD, Vedanthan R, Koethe JR. Prevalence, Risk Factors, and Pathophysiology of Dysglycemia among People Living with HIV in Sub-Saharan Africa. J Diabetes Res 2018; 2018:6916497. [PMID: 30009182 PMCID: PMC5989168 DOI: 10.1155/2018/6916497] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To review available literature on the prevalence, risk factors, pathophysiology, and clinical outcomes of dysglycemia among people living with HIV (PLHIV) in sub-Saharan Africa (SSA). METHODS Database search on PUBMED for eligible studies describing the prevalence, risk factors, pathophysiology, or clinical outcomes of dysglycemia in SSA PLHIV. RESULTS Prevalence of diabetes mellitus (DM) and pre-DM among SSA PLHIV ranged from 1% to 26% and 19% to 47%, respectively, in 15 identified studies. Older age and an elevated body mass index (BMI) were common risk factors for dysglycemia. Risk factors potentially more specific to PLHIV in SSA included exposure to older-generation thymidine analogues or protease inhibitors, malnutrition at ART initiation, a failure to gain fat mass on treatment, and elevated serum lipids. There is evidence of higher nephropathy and neuropathy rates among PLHIV in SSA with comorbid DM compared to HIV-negative individuals with DM. CONCLUSION There is a need for longitudinal studies to enhance understanding of the risk factors for dysglycemia among PLHIV in SSA, further research into optimal therapies to reduce pre-DM progression to DM among SSA PLHIV, and studies of the burden and phenotype of diabetic complications and other health outcomes among PLHIV with comorbid DM in SSA.
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Affiliation(s)
- Benson Njuguna
- Moi Teaching and Referral Hospital, P.O. Box 4606-30100, Eldoret, Kenya
| | - Jepchirchir Kiplagat
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Gerald S. Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute, Duke University, 2400 Pratt Street, Durham, NC 27710, USA
| | - Sonak D. Pastakia
- Purdue University College of Pharmacy, P.O. Box 5760 Eldoret 30100, Kenya
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Department of Medicine and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, P.O. Box 1030, New York, NY 10029, USA
| | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2200-MCN 1161 21st Avenue South, Nashville, TN 37232, USA
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Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, Levitt NS, Mangugu FW, Nyirenda MJ, Ogle GD, Ramaiya K, Sewankambo NK, Sobngwi E, Tesfaye S, Yudkin JS, Basu S, Bommer C, Heesemann E, Manne-Goehler J, Postolovska I, Sagalova V, Vollmer S, Abbas ZG, Ammon B, Angamo MT, Annamreddi A, Awasthi A, Besançon S, Bhadriraju S, Binagwaho A, Burgess PI, Burton MJ, Chai J, Chilunga FP, Chipendo P, Conn A, Joel DR, Eagan AW, Gishoma C, Ho J, Jong S, Kakarmath SS, Khan Y, Kharel R, Kyle MA, Lee SC, Lichtman A, Malm CP, Mbaye MN, Muhimpundu MA, Mwagomba BM, Mwangi KJ, Nair M, Niyonsenga SP, Njuguna B, Okafor OLO, Okunade O, Park PH, Pastakia SD, Pekny C, Reja A, Rotimi CN, Rwunganira S, Sando D, Sarriera G, Sharma A, Sidibe A, Siraj ES, Syed AS, Van Acker K, Werfalli M. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol 2017; 5:622-667. [PMID: 28688818 DOI: 10.1016/s2213-8587(17)30181-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Justine I Davies
- Centre for Global Health, King's College London, Weston Education Centre, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa
| | | | - Till Bärnighausen
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute, KwaZulu, South Africa
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine & Endocrinology, University of Cape Town, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Moffat J Nyirenda
- Department of NCD Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; NCD Theme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW, Australia; Diabetes NSW & ACT, Glebe, NSW, Australia
| | | | - Nelson K Sewankambo
- Department of Medicine, and Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eugene Sobngwi
- University of Newcastle at Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Solomon Tesfaye
- Sheffield Teaching Hospitals and University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Sanjay Basu
- Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Christian Bommer
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Esther Heesemann
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Jennifer Manne-Goehler
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iryna Postolovska
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Vera Sagalova
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Sebastian Vollmer
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania
| | - Benjamin Ammon
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akhila Annamreddi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ananya Awasthi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Agnes Binagwaho
- Harvard Medical School, Harvard University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; University of Global Health Equity, Kigali, Rwanda
| | | | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeanne Chai
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Felix P Chilunga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Anna Conn
- The Fletcher School of Law and Diplomacy, Tufts University, Medford, MA, USA
| | - Dipesalema R Joel
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Arielle W Eagan
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Julius Ho
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simcha Jong
- Leiden University, Science Based Business, Leiden, Netherlands
| | - Sujay S Kakarmath
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Ramu Kharel
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Kyle
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Seitetz C Lee
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amos Lichtman
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Maïmouna N Mbaye
- Clinique Médicale II, Centre de diabétologie Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal
| | - Marie A Muhimpundu
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Mohit Nair
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simon P Niyonsenga
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Obiageli L O Okafor
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Oluwakemi Okunade
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul H Park
- Partners In Health, Rwinkwavu, South Kayonza, Rwanda
| | - Sonak D Pastakia
- Purdue University College of Pharmacy (Purdue Kenya Partnership), Indiana Institute for Global Health, Uasin Gishu, Kenya
| | | | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Rwunganira
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - David Sando
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anshuman Sharma
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Azhra S Syed
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristien Van Acker
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mahmoud Werfalli
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Pastakia SD, Njuguna B, Onyango BA, Washington S, Christoffersen-Deb A, Kosgei WK, Saravanan P. Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods. BMC Pregnancy Childbirth 2017; 17:226. [PMID: 28705184 PMCID: PMC5513206 DOI: 10.1186/s12884-017-1415-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 12/09/2016] [Accepted: 07/05/2017] [Indexed: 01/11/2023] Open
Abstract
Background Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting. Methods Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference. Results Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity. Conclusions POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required. Trials registration Clinical trials.gov: NCT02978807, Registered 29 November 2016.
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Affiliation(s)
- Sonak D Pastakia
- Department of Pharmacy Practice, Purdue Kenya Partnership, PO Box 5760, Eldoret, 30100, Kenya.
| | - Benson Njuguna
- Department of Pharmacy, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya
| | - Beryl Ajwang' Onyango
- Department of Pharmacy, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya
| | - Sierra Washington
- Department of Reproductive Medicine, University of California, San Diego, CA, 92103, USA
| | | | - Wycliffe K Kosgei
- Division of Reproductive Health, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya
| | - Ponnusamy Saravanan
- Department of Diabetes, Endocrinology & Metabolism, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Diabetes and Endocrine Centre, George Eliot Hospital, Nuneaton, CV107DJ, UK
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Pastakia SD, Pekny CR, Manyara SM, Fischer L. Diabetes in sub-Saharan Africa - from policy to practice to progress: targeting the existing gaps for future care for diabetes. Diabetes Metab Syndr Obes 2017; 10:247-263. [PMID: 28790858 PMCID: PMC5489055 DOI: 10.2147/dmso.s126314] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The global prevalence and impact of diabetes has increased dramatically, particularly in sub-Saharan Africa. This region faces unique challenges in combating the disease including lack of funding for noncommunicable diseases, lack of availability of studies and guidelines specific to the population, lack of availability of medications, differences in urban and rural patients, and inequity between public and private sector health care. Because of these challenges, diabetes has a greater impact on morbidity and mortality related to the disease in sub-Saharan Africa than any other region in the world. In order to address these unacceptably poor trends, contextualized strategies for the prevention, identification, management, and financing of diabetes care within this population must be developed. This narrative review provides insights into the policy landscape, epidemiology, pathophysiology, care protocols, medication availability, and health care systems to give readers a comprehensive summary of many factors in these domains as they pertain to diabetes in sub-Saharan Africa. In addition to providing a review of the current evidence available in these domains, potential solutions to address the major gaps in care will be proposed to reverse the negative trends seen with diabetes in sub-Saharan Africa.
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Affiliation(s)
- Sonak D Pastakia
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA
| | - Chelsea R Pekny
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA
| | - Simon M Manyara
- Department of Pharmacy, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lydia Fischer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Vedanthan R, Kamano JH, Lee H, Andama B, Bloomfield GS, DeLong AK, Edelman D, Finkelstein EA, Hogan JW, Horowitz CR, Manyara S, Menya D, Naanyu V, Pastakia SD, Valente TW, Wanyonyi CC, Fuster V. Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study. Am Heart J 2017; 188:175-185. [PMID: 28577673 DOI: 10.1016/j.ahj.2017.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/17/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with >80% of CVD deaths occurring in low and middle income countries (LMICs). Diabetes mellitus and pre-diabetes are risk factors for CVD, and CVD is the major cause of morbidity and mortality among individuals with DM. There is a critical period now during which reducing CVD risk among individuals with diabetes and pre-diabetes may have a major impact. Cost-effective, culturally appropriate, and context-specific approaches are required. Two promising strategies to improve health outcomes are group medical visits and microfinance. METHODS/DESIGN This study tests whether group medical visits integrated into microfinance groups are effective and cost-effective in reducing CVD risk among individuals with diabetes or at increased risk for diabetes in western Kenya. An initial phase of qualitative inquiry will assess contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance for CVD risk reduction. Subsequently, we will conduct a four-arm cluster randomized trial comparing: (1) usual clinical care, (2) usual clinical care plus microfinance groups only, (3) group medical visits only, and (4) group medical visits integrated into microfinance groups. The primary outcome measure will be 1-year change in systolic blood pressure, and a key secondary outcome measure is 1-year change in overall CVD risk as measured by the QRISK2 score. We will conduct mediation analysis to evaluate the influence of changes in social network characteristics on intervention outcomes, as well as moderation analysis to evaluate the influence of baseline social network characteristics on effectiveness of the interventions. Cost-effectiveness analysis will be conducted in terms of cost per unit change in systolic blood pressure, percent change in CVD risk score, and per disability-adjusted life year saved. DISCUSSION This study will provide evidence regarding effectiveness and cost-effectiveness of interventions to reduce CVD risk. We aim to produce generalizable methods and results that can provide a model for adoption in low-resource settings worldwide.
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Pastakia SD, Manyara SM, Vedanthan R, Kamano JH, Menya D, Andama B, Chesoli C, Laktabai J. Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya. J Gen Intern Med 2017; 32:540-548. [PMID: 27921256 PMCID: PMC5400758 DOI: 10.1007/s11606-016-3918-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 04/18/2016] [Revised: 09/08/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Rural settings in Sub-Saharan Africa (SSA) consistently report low participation in non-communicable disease (NCD) treatment programs and poor outcomes. OBJECTIVE The objective of this study is to assess the impact of the implementation of a patient-centered rural NCD care delivery model called Bridging Income Generation through grouP Integrated Care (BIGPIC). DESIGN The study prospectively tracked participation and health outcomes for participants in a screening event and compared linkage frequencies to a historical comparison group. PARTICIPANTS Rural Kenyan participants attending a voluntary NCD screening event were included within the BIGPIC model of care. INTERVENTIONS The BIGPIC model utilizes a contextualized care delivery model designed to address the unique barriers faced in rural settings. This model emphasizes the following steps: (1) find patients in the community, (2) link to peer/microfinance groups, (3) integrate education, (4) treat in the community, (5) enhance economic sustainability and (6) generate demand for care through incentives. MAIN MEASURES The primary outcome is the linkage frequency, which measures the percentage of patients who return for care after screening positive for either hypertension and/or diabetes. Secondary measures include retention frequencies defined as the percentage of patients remaining engaged in care throughout the 9-month follow-up period and changes in systolic (SBP) and diastolic blood pressure (DBP) and blood sugar over 12 months. KEY RESULTS Of the 879 individuals who were screened, 14.2 % were confirmed to have hypertension, while only 1.4 % were confirmed to have diabetes. The implementation of a comprehensive microfinance-linked, community-based, group care model resulted in 72.4 % of screen-positive participants returning for subsequent care, of which 70.3 % remained in care through the 12 months of the evaluation period. Patients remaining in care demonstrated a statistically significant mean decline of 21 mmHg in SBP [95 % CI (13.9 to 28.4), P < 0.01] and 5 mmHg drop in DBP [95 % CI (1.4 to 7.6), P < 0.01]. CONCLUSIONS The implementation of a contextualized care delivery model built around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction.
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Affiliation(s)
- Sonak D Pastakia
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.
- Moi Teaching and Referral Hospital, Eldoret, Kenya.
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- College of Pharmacy, Purdue University, West Lafayette, IN, USA.
| | - Simon M Manyara
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | | | - Jemima H Kamano
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Diana Menya
- College of Health Sciences, School of Public Health, Moi University, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Cleophas Chesoli
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Jeremiah Laktabai
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Webuye District Hospital, Webuye, Kenya
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Tran DN, Njuguna B, Mercer T, Manji I, Fischer L, Lieberman M, Pastakia SD. Ensuring Patient-Centered Access to Cardiovascular Disease Medicines in Low-Income and Middle-Income Countries Through Health-System Strengthening. Cardiol Clin 2017; 35:125-134. [DOI: 10.1016/j.ccl.2016.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Barasa FA, Vedanthan R, Pastakia SD, Crowe SJ, Aruasa W, Sugut WK, White R, Ogola ES, Bloomfield GS, Velazquez EJ. Approaches to Sustainable Capacity Building for Cardiovascular Disease Care in Kenya. Cardiol Clin 2016; 35:145-152. [PMID: 27886785 DOI: 10.1016/j.ccl.2016.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 01/25/2023]
Abstract
Cardiovascular diseases are approaching epidemic levels in Kenya and other low- and middle-income countries without accompanying effective preventive and therapeutic strategies. This is happening in the background of residual and emerging infections and other diseases of poverty, and increasing physical injuries from traffic accidents and noncommunicable diseases. Investments to create a skilled workforce and health care infrastructure are needed. Improving diagnostic capacity, access to high-quality medications, health care, appropriate legislation, and proper coordination are key components to ensuring the reversal of the epidemic and a healthy citizenry. Strong partnerships with the developed countries also crucial.
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Affiliation(s)
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Susie J Crowe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
| | | | | | - Russ White
- Tenwek Mission Hospital, Bomet, Kenya; Alpert School of Medicine, Brown University, 2 Dudley Street, PO Box 39, Providence, RI 02905, USA
| | - Elijah S Ogola
- Department of Clinical Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Gerald S Bloomfield
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Eric J Velazquez
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
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Bhavadharini B, Anjana RM, Mahalakshmi MM, Maheswari K, Kayal A, Unnikrishnan R, Ranjani H, Ninov L, Pastakia SD, Usha S, Malanda B, Belton A, Uma R, Mohan V. Glucose tolerance status of Asian Indian women with gestational diabetes at 6weeks to 1year postpartum (WINGS-7). Diabetes Res Clin Pract 2016; 117:22-7. [PMID: 27329018 DOI: 10.1016/j.diabres.2016.04.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/12/2016] [Accepted: 04/26/2016] [Indexed: 01/18/2023]
Abstract
AIM To determine postpartum glucose tolerance status among women with gestational diabetes mellitus (GDM) recruited under the Women In India with GDM Strategy (WINGS) Model of Care (MOC). METHODS Through the WINGS MOC programme, 212 women with GDM were followed till delivery between November 2013 and August 2015. All women were advised to return for a postpartum oral glucose tolerance test (OGTT) 6-12weeks after delivery. A multivariate logistic regression (MLR) model was developed to identify the risk factors for postpartum dysglycemia which was defined as presence of diabetes (DM) or prediabetes. RESULTS 203/212(95.8%) women completed their postpartum OGTT. Of the 161 women (79.3%) who came back for the test between 6 and 12weeks, 2(1.2%) developed DM, 5(3.1%), isolated IFG, 13(8.1%), isolated IGT and 5(3.1%) combined IFG/IGT [dysglycemia 25(15.5%)]. 136 women (84.5%) reverted to normal glucose tolerance (NGT). Of the 42 women who came back between 12weeks and a year, 5(11.9%) developed DM, 10(23.8%), isolated IFG and 1(2.4%) combined IFG/IGT [dysglycemia 16(38.1%)]. 26/42 women (61.9%) reverted to NGT. Thus overall dysglycemia occurred in 41/203 women (20.2%). MLR showed that BMI ⩾25kg/m(2) was significantly associated with postpartum dysglycemia (odds ratio: 4.47; 95% confidence interval: 1.8-11.2, p=0.001). CONCLUSION Among Asian Indian women with GDM, over 20% develop dysglycemia within one year postpartum, and BMI ⩾25kg/m(2) increased this risk four-fold. Early postpartum screening can identify high risk women and help plan strategies for prevention of type 2 diabetes in the future.
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Affiliation(s)
| | | | | | | | | | | | | | - Lyudmil Ninov
- International Diabetes Federation, Brussels, Belgium
| | | | - Sriram Usha
- Associates in Clinical Endocrinology Education and Research (ACEER), Chennai, India
| | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- International Diabetes Federation, Brussels, Belgium
| | - Ram Uma
- Seethapathy Clinic and Hospital, Chennai, India
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Anjana RM, Sudha V, Lakshmipriya N, Anitha C, Unnikrishnan R, Bhavadharini B, Mahalakshmi MM, Maheswari K, Kayal A, Ram U, Ranjani H, Ninov L, Deepa M, Pradeepa R, Pastakia SD, Malanda B, Belton A, Mohan V. Physical activity patterns and gestational diabetes outcomes - The wings project. Diabetes Res Clin Pract 2016; 116:253-62. [PMID: 27321343 DOI: 10.1016/j.diabres.2016.04.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/15/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare physical activity (PA) patterns in pregnant woman with and without gestational diabetes (GDM) and to assess the effects of an exercise intervention on change in PA patterns, blood glucose levels and pregnancy outcomes in GDM women. METHODS For the first objective, PA patterns were studied in 795 pregnant women with and without GDM. For the second objective, the Women in India with Gestational Diabetes Strategy-Model of Care (WINGS-MOC) intervention were evaluated in 151 women out of 189 with GDM. PA was assessed using a validated questionnaire and a pedometer. Changes in PA patterns, glycemic parameters and neonatal outcomes were evaluated. RESULTS Overall, only 10% of pregnant women performed recommended levels of PA. Women with GDM were significantly more sedentary compared to those without GDM (86.2 vs. 61.2%, p<0.001). After the MOC was implemented in women with GDM, there was a significant improvement in PA and a decrease in sedentary behaviour amongst women (before MOC, moderate activity: 15.2%, sedentary: 84.8% vs. after MOC-moderate: 26.5%, sedentary: 73.5%; p<0.001), and an increase in their daily step count from 2206/day to 2476/day (p<0.001). Fasting 1 and 2-h postprandial glucose values significantly decreased (p<0.001 for all). Sedentary behaviour was associated with a fourfold higher risk (p=0.02), and recreational walking with 70% decreased risk, of adverse neonatal outcomes (p=0.04) after adjusting for potential confounders. CONCLUSIONS PA levels are inadequate amongst this group of pregnant women studied i.e. those with and without GDM. However, a low-cost, culturally appropriate MOC can bring about significant improvements in PA in women with GDM. These changes are associated with improved glycemic control and reduction in adverse neonatal outcomes.
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Affiliation(s)
- Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India.
| | - Vasudevan Sudha
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Nagarajan Lakshmipriya
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Chandrasekaran Anitha
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Balaji Bhavadharini
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Manni Mohanraj Mahalakshmi
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Kumar Maheswari
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Arivudainambi Kayal
- Department of Policy and Programme, International Diabetes Federation, Brussels, Belgium
| | - Uma Ram
- SeethapathyClinic and Hospital, Chennai, India
| | - Harish Ranjani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Lyudmil Ninov
- Department of Policy and Programme, International Diabetes Federation, Brussels, Belgium
| | - Mohan Deepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
| | - Sonak D Pastakia
- Department of Pharmacy Practice Personnel, Colleges of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Belma Malanda
- Department of Policy and Programme, International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- Department of Policy and Programme, International Diabetes Federation, Brussels, Belgium
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Gopalapuram, Chennai, India
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Binanay CA, Akwanalo CO, Aruasa W, Barasa FA, Corey GR, Crowe S, Esamai F, Einterz R, Foster MC, Gardner A, Kibosia J, Kimaiyo S, Koech M, Korir B, Lawrence JE, Lukas S, Manji I, Maritim P, Ogaro F, Park P, Pastakia SD, Sugut W, Vedanthan R, Yanoh R, Velazquez EJ, Bloomfield GS. Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya. J Am Coll Cardiol 2016; 66:2550-60. [PMID: 26653630 DOI: 10.1016/j.jacc.2015.09.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 07/14/2015] [Revised: 09/06/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource-limited setting. Our experiences may guide the development of similar collaborations in other settings.
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Affiliation(s)
- Cynthia A Binanay
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | | | | | | | - G Ralph Corey
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Susie Crowe
- Purdue University College of Pharmacy, West Lafayette, Indiana
| | - Fabian Esamai
- College of Health Sciences, Moi University, Eldoret, Kenya
| | | | | | | | - John Kibosia
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Moi Teaching and Referral Hospital, Eldoret, Kenya; College of Health Sciences, Moi University, Eldoret, Kenya
| | - Myra Koech
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Belinda Korir
- Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | - John E Lawrence
- Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina
| | - Stephanie Lukas
- Purdue University College of Pharmacy, West Lafayette, Indiana
| | - Imran Manji
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | - Peter Park
- Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina; Indiana University, Indianapolis, Indiana
| | | | - Wilson Sugut
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Reuben Yanoh
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Eric J Velazquez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina.
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47
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Bhavadharini B, Mahalakshmi MM, Anjana RM, Maheswari K, Uma R, Deepa M, Unnikrishnan R, Ranjani H, Pastakia SD, Kayal A, Ninov L, Malanda B, Belton A, Mohan V. Prevalence of Gestational Diabetes Mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol 2016; 2:8. [PMID: 28702243 PMCID: PMC5471800 DOI: 10.1186/s40842-016-0028-6] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/31/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To determine the prevalence of Gestational Diabetes Mellitus (GDM) in urban and rural Tamil Nadu in southern India, using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization (WHO) 1999 criteria for GDM. METHODS A total of 2121 pregnant women were screened for GDM from antenatal clinics in government primary health centres of Kancheepuram district (n = 520) and private maternity centres in Chennai city in Tamil Nadu (n = 1601) between January 2013 to December 2014. Oral glucose tolerance tests (OGTT) were done after an overnight fast of at least 8 h, using a 75 g glucose load and venous samples were drawn at 0, 1 and 2 h. GDM was diagnosed using both the IADPSG criteria as well as the WHO 1999 criteria for GDM. RESULTS The overall prevalence of GDM after adjusting for age, BMI, family history of diabetes and previous history of GDM was 18.5 % by IADPSG criteria with no significant urban/rural differences (urban 19.8 % vs rural 16.1 %, p = 0.46). Using the WHO 1999 criteria, the overall adjusted prevalence of GDM was 14.6 % again with no significant urban/rural differences (urban 15.9 % vs rural 8.9 %, p = 0.13). CONCLUSION The prevalence of GDM by IADPSG was high both using IADPSG as well as WHO 1999 criteria with no significant urban/rural differences. This emphasizes the need for increasing awareness about GDM and for prevention of GDM in developing countries like India.
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Affiliation(s)
- Balaji Bhavadharini
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | | | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | - Kumar Maheswari
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | - Ram Uma
- Seethapathy Clinic and Hospital, Chennai, India
| | - Mohan Deepa
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | - Harish Ranjani
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
| | | | | | - Lyudmil Ninov
- International Diabetes Federation, Brussels, Belgium
| | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- International Diabetes Federation, Brussels, Belgium
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India
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48
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Miller ML, Karwa R, Schellhase EM, Pastakia SD, Crowe S, Manji I, Jakait B, Maina M. Meeting the Needs of Underserved Patients in Western Kenya by Creating the Next Generation of Global Health Pharmacists. Am J Pharm Educ 2016; 80:22. [PMID: 27073275 PMCID: PMC4827573 DOI: 10.5688/ajpe80222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/16/2015] [Indexed: 05/11/2023]
Abstract
Objective. To describe a novel training model used to create a sustainable public health-focused pharmacy residency based in Kenya and to describe the outcomes of this training program on underserved populations. Design. The postgraduate year 2 residency was designed to expose trainees to the unique public health facets of inpatient, outpatient, and community-based care delivery in low and middle-income countries. Public health areas of focus included supply chain management, reproductive health, pediatrics, HIV, chronic disease management, and teaching. Assessment. The outcomes of the residency were assessed based on the number of new clinical programs developed by residents, articles and abstracts written by residents, and resident participation in grant writing. To date, six residents from the United States and eight Kenyan residents have completed the residency. Eleven sustainable patient care services have been implemented as a result of the residency program. Conclusion. This pharmacy residency training model developed accomplished pharmacists in public health pharmacy, with each residency class expanding funding and clinical programming, contributing to curriculum development, and creating jobs.
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Affiliation(s)
- Monica L. Miller
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana
- Eskenazi Health, Department of Pharmacy Services, Indianapolis Indiana
| | - Rakhi Karwa
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana
| | | | - Sonak D. Pastakia
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana
| | - Susie Crowe
- Purdue University Global Health Residency Program, Eldoret, Kenya
| | - Imran Manji
- Academic Model Providing Access to Healthcare (AMPATH) Eldoret, Kenya
| | - Beatrice Jakait
- Academic Model Providing Access to Healthcare (AMPATH) Eldoret, Kenya
| | - Mercy Maina
- Academic Model Providing Access to Healthcare (AMPATH) Eldoret, Kenya
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49
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Manji I, Manyara SM, Jakait B, Ogallo W, Hagedorn IC, Lukas S, Kosgei EJ, Pastakia SD. The Revolving Fund Pharmacy Model: backing up the Ministry of Health supply chain in western Kenya. Int J Pharm Pract 2016; 24:358-66. [PMID: 26913925 DOI: 10.1111/ijpp.12254] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A pressing challenge in low and middle-income countries (LMIC) is inadequate access to essential medicines, especially for chronic diseases. The Revolving Fund Pharmacy (RFP) model is an initiative to provide high-quality medications consistently to patients, using revenues generated from the sale of medications to sustainably resupply medications. This article describes the utilization of RFPs developed by the Academic Model Providing Access to Healthcare (AMPATH) with the aim of stimulating the implementation of similar models elsewhere to ensure sustainable access to quality and affordable medications in similar LMIC settings. METHODS The service evaluation of three pilot RFPs started between April 2011 and January 2012 in select government facilities is described. The evaluation assessed cross-sectional availability of essential medicines before and after implementation of the RFPs, number of patient encounters and the impact of community awareness activities. FINDINGS Availability of essential medicines in the three pilot RFPs increased from 40%, 36% and <10% to 90%, 94% and 91% respectively. After the first year of operation, the pilot RFPs had a total of 33 714 patient encounters. As of February 2014, almost 3 years after starting up the first RFP, the RFPs had a total of 115 991 patient encounters. In the Eldoret RFP, community awareness activities led to a 51% increase in sales. CONCLUSIONS With proper oversight and stakeholder involvement, this model is a potential solution to improve availability of essential medicines in LMICs. These pilots exemplify the feasibility of implementing and scaling up this model in other locations.
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Affiliation(s)
- Imran Manji
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - Simon M Manyara
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Beatrice Jakait
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - William Ogallo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Biomedical Informatics, Columbia University Medical Center, New York, IN, United States
| | - Isabel C Hagedorn
- Department of Pharmacy Practice, Butler University, College of Pharmacy and Health Sciences, Indianapolis, IN, United States
| | - Stephanie Lukas
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Eunice J Kosgei
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak D Pastakia
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, United States
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50
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Wambui Charity K, Kumar AMV, Hinderaker SG, Chinnakali P, Pastakia SD, Kamano J. Do diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya. Diabetes Res Clin Pract 2016; 112:37-43. [PMID: 26655019 DOI: 10.1016/j.diabres.2015.11.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/21/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022]
Abstract
AIMS Among diabetes mellitus (DM) patients with poor glycemic control enrolled into a self-monitoring of blood glucose (SMBG) program in Kenya, to assess the level of SMBG adherence, its associated factors and its relation to glycemic control (defined as HbA1c <7% and/or 2% absolute reduction relative to baseline). METHODS In this retrospective cohort study, we used routinely collected data of patients enrolled during 2012-2013. We assessed adherence to SMBG by dividing the number of glucose tests performed by the number recommended. A level of ≥ 80% was considered 'good adherence'. Glycemic control was considered as absolute change from baseline of 2%. RESULTS Of 164 patients (59% female; 76% rural), the proportions with good SMBG adherence were 34%, 17%, 15% and 10% during 0-6, 7-12, 13-18 and 19-24 months into the HGM program respectively. In multivariate analysis, male gender, urban place of residence and payment for glucostrips were associated with poor adherence during 0-12 months. The mean reduction in HbA1c compared to baseline was 1.2%, 1.1%, 0.8% and 0.7% at 6, 12, 18 and 24 months, respectively. We did not find any association between SMBG adherence and glycemic control. CONCLUSIONS Adherence to SMBG was sub-optimal, especially among those who had to pay for glucostrips. Patient education and provision of free glucostrips are recommended to improve adherence and glycemic control.
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Affiliation(s)
- K Wambui Charity
- Academic Model Providing Access to Healthcare, P. O. Box 4606, Eldoret, 30100, Kenya.
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C6, Qutub Institutional Area, New Delhi 110016, India.
| | - Sven Gudmund Hinderaker
- The Centre for International Health, University of Bergen Overlege Danielsens Hus, Årstadveien 21, Bergen, 5020, Norway.
| | - Palanivel Chinnakali
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Puducherry 605006, India.
| | - Sonak D Pastakia
- Purdue University College of Pharmacy, W7555 Myers Building, 1001W. 10th Street, Indianapolis, IN, USA.
| | - Jemimah Kamano
- Department of Internal Medicine, College of Health Sciences, School of Medicine, Moi University, P.O. Box 4606, Eldoret, 30100, Kenya.
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