Browsing by Author "McHenry, Megan"

Now showing 1 - 4 of 4
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    Effects of economic interventions on pediatric and adolescent HIV care outcomes: a systematic review
    (Taylor & Francis, 2024) Bosma, Christopher B.; Toromo, Judith J.; Ayers, Morgan J.; Foster, Erin D.; McHenry, Megan; Enane, Leslie A.; Medicine, School of Medicine
    Economic insecurity and poverty present major barriers to HIV care for young people. We conducted a systematic review of the current evidence for the effect of economic interventions on HIV care outcomes among pediatric populations encompassing young children, adolescents, and youth (ages 0-24). We conducted a search of PubMed MEDLINE, Cochrane, Embase, Scopus, CINAHL, and Global Health databases on October 12, 2022 using a search strategy curated by a medical librarian. Studies included economic interventions targeting participants <25 years in age which measured clinical HIV outcomes. Study characteristics, care outcomes, and quality were independently assessed, and findings were synthesized. Title/abstract screening was performed for 1934 unique records. Thirteen studies met inclusion criteria, reporting on nine distinct interventions. Economic interventions included incentives (n = 5), savings and lending programs (n = 3), and government cash transfers (n = 1). Study designs included three randomized controlled trials, an observational cohort study, a matched retrospective cohort study, and pilot intervention studies. While evidence is very limited, some promising findings were observed supporting retention and viral suppression, particularly for those with suboptimal care engagement or with detectable viral load. There is a need to further study and optimize economic interventions for children and adolescents living with HIV.
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    Global health electives in the COVID-19 era: resuming travel and strengthening global health academic partnerships
    (IJME, 2022-05) Haq, Heather; Msekandiana, Amos; Matshaba, Mogomotsi; Thahane, Linoeo; Watts, Jennifer; Tam, Reena; St Clair, Nicole; Schubert, Charles; Rule, Amy; Pannaraj, Pia; Pitt, Michael; Oleson, David; Murray, Brittany; Morris, Lee; Mendoza, Joanne; McHenry, Megan; Keating, Elizabeth; Ferrer, Kathy; Crouse, Heather; Condurache, Tania; Batra, Maneesh; Barnes, Adelaide; Conway, James; Pediatrics, School of Medicine
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    "If We Manage Early, We Can Get It Right": A Descriptive Study of Healthcare Workers' Experiences Managing Sepsis at a Kenyan Referral Hospital
    (Springer Nature, 2025-02-14) Srour, Maria; Ali, Shamim; Hodge, Matthew; Kwobah, Charles; McHenry, Megan; Etling, Mary Ann; Nafiseh, Amira; Khan, Babar; Prohaska, Clare C.; Navuluri, Neelima; Medicine, School of Medicine
    Background and objectives: Sepsis and septic shock are conditions of high mortality across the globe. Despite the efforts of the Surviving Sepsis Campaign, improvements in outcomes for patients with sepsis and septic shock have been mostly seen in high-income countries (HICs), leaving low- and middle-income countries (LMICs) to bear most of the global disease burden. This paper utilizes a socio-ecological model to describe the lived experiences of local healthcare workers treating sepsis and septic shock at a large referral hospital in Western Kenya. These perspectives shed light on barriers and strengths in care, gaps in knowledge, and areas of high-yield improvement. Materials and methods: This is a descriptive analysis focused on providers caring for patients with sepsis and septic shock. Twenty-seven interviews with a wide variety of purposively sampled patient-facing and ancillary medical staff were performed. Concurrent thematic analysis took place as interviews were being conducted. The concept presented was inductively and deductively reasoned and analyzed using a socio-ecological framework. We chose to present three levels of influence on the individual provider. Results: We present our results using a socio-ecological model. At the health system level, we found that most patients do not have healthcare coverage, which drives up out-of-pocket expenses for individuals. At the hospital level, capacity limits, particularly personnel shortages and small intensive care unit (ICU) spaces, influence care. At the interdisciplinary level, relationships between providers and other members of the healthcare team can present challenges. Lastly, these system-, hospital-, and interdisciplinary-level challenges make guideline adherence difficult and not always feasible for individual providers. Conclusions: To our knowledge, this is the first study to give voice to local providers treating patients with sepsis at a referral center in Western Kenya. By presenting findings in the socio-ecological model, we are able to organize potential interventions for the improvement of care at various levels. We found high-yield areas for improving care including establishing clear protocols for task assignments and communication, increasing the number of trained personnel both in the general wards and in the ICU, and, on a broader scale, advocating for expanded healthcare coverage for all Kenyans. This work provides a framework for further investigation into elements of sepsis care and the creation of locally relevant treatment guidelines in sub-Saharan Africa and across LMICs.
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    A Qualitative Examination of Perceived Stigma and its Sources Among Adolescents Living With HIV in Western Kenya
    (Sage, 2022) Callen, Grant; Chory, Ashley; Sang, Festus; Munyoro, Dennis; Aluoch, Josephine; Scanlon, Michael; Enane, Leslie; McHenry, Megan; Wools-Kaloustian, Kara; Apondi, Edith; Vreeman, Rachel; Pediatrics, School of Medicine
    Introduction. Adolescents (10-19 years) living with HIV (ALWH) face unique challenges in controlling HIV long-term, including stigma and perception of stigma within their communities. Methods. We conducted a qualitative investigation of the sources of perceived HIV-related stigma with ALWH in western Kenya. Forty-six ALWH on ART, aware of their status, and engaged in care were enrolled. Interviews explored perceived stigma by probing the individuals and experiences that adolescents identify as causing or perpetuating their ongoing fears. Results. Participants (54% male, mean age 17.4) reported ongoing fears of stigmatization related to friends and peers not living with HIV. They described previous enacted and first-hand observations of stigma, most often occurring in pre-adolescence, by age mates or peers at school as the most common cause for their ongoing fears. Conclusions. Perceived stigma is prevalent among ALWH and develops from experiences in pre-adolescence. Anti-HIV stigma interventions addressing educators and children in school settings to combat perceived stigma at its source should be investigated.