Browsing by Author "Njuguna, Benson"

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    Community-based medication delivery program for antihypertensive medications improves adherence and reduces blood pressure
    (PLOS, 2022-09) Tran, Dan N.; Kangogo, Kibet; Amisi, James A.; Kamadi, James; Karwa, Rakhi; Kiragu, Benson; Laktabai, Jeremiah; Manji, Imran N.; Njuguna, Benson; Szkwarko, Daria; Qian, Kun; Vedanthan, Rajesh; Pastakia, Sonak D.; Medicine, School of Medicine
    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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    Ensuring Patient-Centered Access to Cardiovascular Disease Medicines in Low-Income and Middle-Income Countries Through Health-System Strengthening
    (Elsevier, 2017) Tran, Dan N.; Njuguna, Benson; Mercer, Timothy; Manji, Imran; Fischer, Lydia; Lieberman, Marya; Pastakia, Sonak; Medicine, School of Medicine
    Cardiovascular disease (CVD) is the leading cause of global mortality and is expected to reach 23 million deaths by 2030. 80% of CVD deaths occur in low- and middle- income countries (LMICs). Although CVD prevention and treatment guidelines are available, translating these into practice is hampered in LMICs by inadequate healthcare systems which limit access to lifesaving medications. In this review article, we describe the deficiencies in the current LMIC supply chains that limit access to effective CVD medicines, and discuss existing solutions that are translatable to similar settings in order to address these deficiencies.
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    Infective Endocarditis in Low- And Middle-Income Countries
    (Elsevier, 2017-02) Njuguna, Benson; Gardner, Adrian; Karwa, Rakhi; Delahaye, François; Department of Medicine, School of Medicine
    Infective endocarditis (IE) is a rare, life-threatening disease with a mortality rate of upto 25% and significant debilitating morbidities. Although much has been reported on contemporary IE in high income countries, conclusions on the state of IE in low and middle income countries (LMICs) are based on studies conducted before the year 2000. Furthermore, unique challenges in the diagnosis and management of IE persist in LMICs. This article is a review of IE studies conducted in LMICs documenting clinical experiences from the year 2000 to present. We present the causes of IE, management of patients with IE and the prevailing challenges in diagnosis and treatment of IE in LMICs.
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    Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) in western Kenya: a study protocol of a cluster randomized trial
    (BioMed Central, 2019-09-09) Mercer, Tim; Njuguna, Benson; Bloomfield, Gerald S.; Dick, Jonathan; Finkelstein, Eric; Kamano, Jemima; Mwangi, Ann; Naanyu, Violet; Pastakia, Sonak D.; Valente, Thomas W.; Vedanthan, Rajesh; Akwanalo, Constantine; Medicine, School of Medicine
    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.
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    To address emerging infections, we must invest in enduring systems: The kinetics and dynamics of health systems strengthening
    (Wiley, 2015-10) Pastakia, Sonak; Njuguna, Benson; Le, Phuoc V.; Singh, Manisha K.; Brock, Tina Penick; Department of Medicine, IU School of Medicine
    Clinical pharmacology uses foundational principles of pharmacokinetics (PK) and pharmacodynamics (PD) to address medication use spanning a continuum from molecules to the masses. In the realm of infectious diseases, PK/PD attributes are considered especially important, because subtherapeutic dosing of antibiotics has been associated with poorer clinical outcomes in patients and increased incidences of drug resistance in populations. In consideration of these PK/PD principles, we will describe the analogous relationship between health systems strengthening, including for educating healthcare providers about emerging infections, and the tenets of therapeutic drug monitoring.