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Browsing by Author "Nyandiko, Winstone"
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Item A Global Health Reciprocal Innovation grant programme: 5-year review with lessons learnt(BMJ Publishing, 2023) Ruhl, Laura J.; Kiplagat, Jepchirchir; O'Brien, Rishika; Wools-Kaloustian, Kara; Scanlon, Michael; Plater, David; Thomas, Melissa R.; Pastakia, Sonak; Gopal-Srivastava, Rashmi; Morales-Soto, Nydia; Nyandiko, Winstone; Vreeman, Rachel C.; Litzelman, Debra K.; Laktabai, Jeremiah; Medicine, School of MedicineUnilateral approaches to global health innovations can be transformed into cocreative, uniquely collaborative relationships between low-income and middle-income countries (LMICs) and high-income countries (HIC), constituted as 'reciprocal innovation' (RI). Since 2018, the Indiana Clinical and Translational Sciences Institute (CTSI) and Indiana University (IU) Center for Global Health Equity have led a grants programme sculpted from the core elements of RI, a concept informed by a 30-year partnership started between IU (Indiana) and Moi University (Kenya), which leverages knowledge sharing, transformational learning and translational innovations to address shared health challenges. In this paper, we describe the evolution and implementation of an RI grants programme, as well as the challenges faced. We aim to share the successes of our RI engagement and encourage further funding opportunities to promote innovations grounded in the RI core elements. From the complex series of challenges encountered, three major lessons have been learnt: dedicating extensive time and resources to bring different settings together; establishing local linkages across investigators; and addressing longstanding inequities in global health research. We describe our efforts to address these challenges through educational materials and an online library of resources for RI projects. Using perspectives from RI investigators funded by this programme, we offer future directions resulting from our 5-year experience in applying this RI-focused approach. As the understanding and implementation of RI grow, global health investigators can share resources, knowledge and innovations that have the potential to significantly change the face of collaborative international research and address long-standing health inequities across diverse settings.Item The Academic Model Providing Access To Healthcare (AMPATH) in Kenya(Global Livestock CRSP, UC Davis, 2008-11) Nyandiko, Winstone; Siika, Abraham; Ernst, Judith A.; Ettyang, Grace; Neumann, Charlotte; Yiannoutsos, ConstantinIn sub-Saharan Africa, an estimated 28 million people are living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In 2001, Moi University in Eldoret, Kenya joined with Kenya’s second national referral hospital, Moi Teaching and Referral Hospital (MTRH) and Indiana University (IU) to establish the Academic Model Providing Access To Healthcare (AMPATH). AMPATH’s missions were to (1) provide high-quality patient care; (2) educate patients and health care providers; and (3) establish a laboratory for clinical research in HIV/AIDS (http://medicine.iupui.edu/kenya/hiv.aids.html). Leveraging the power of an academic medical partnership, AMPATH has quickly become one of the largest and most comprehensive HIV/AIDS control systems in sub-Saharan Africa, providing a comprehensive system of care that has been described as a model of sustainable development (Tobias, 2006). Delivery of services occurs in the public sector through hospitals and health centers run by Kenya’s Ministry of Health. AMPATH currently implements prevention activities that touch the lives of millions of persons in a wide geographic area. The research arm of AMPATH, created to facilitate and manage the international research agenda being generated by Kenyan and US faculty, includes the Global Livestock CRSP’s HIV Nutrition Project (HNP), “Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children,” which is a collaborative initiative between AMPATH and faculty from Moi University, Indiana University and the University of California, Los Angeles.Item A Challenging Knowledge Gap: Estimating Modes of HIV Acquisition Among Adolescents Entering HIV Care During Adolescence(Sage, 2022-05-31) Humphrey, John; Triedman, Miranda; Nyandiko, Winstone; Sang, Edwin; Kemboi, Emmanuel; Alera, Marsha; Novitsky, Vlad; Manne, Akarsh; Jepkemboi, Eslyne; Orido, Millicent; Apondi, Edith; Vreeman, Rachel; Wools-Kaloustian, Kara; Kantor, Rami; Medicine, School of MedicineCharacterizing HIV acquisition modes among adolescents with HIV (AHIV) enrolling in care during adolescence is a challenging gap that impacts differential interventions. We explored whether primary data collection with targeted questionnaires may address this gap and improve understanding of risk factors and perceptions about adolescents' HIV acquisition, in Kenyan AHIV entering care at ≥10 years, and their mothers with HIV (MHIV). Clinical data were derived through chart review. Among 1073 AHIV in care, only 26 (2%) met eligibility criteria of being ≥10 years at care enrollment, disclosed to, and with living MHIV. Among 18/26 AHIV-MHIV dyads enrolled (median age of AHIV 14 years), none had documented HIV acquisition modes. Data suggested perinatal infection in 17/18 AHIV, with 1 reported non-perinatal acquisition risk factor, and some discordance between adolescent-mother perceptions of HIV acquisition. In this difficult-to-enroll, vulnerable population of AHIV-MHIV dyads, primary data collection can enhance understanding of AHIV acquisition modes.Item Community Perspectives on Research Consent Involving Vulnerable Children in Western Kenya(2012-10) Vreeman, Rachel; Kamaara, Eunice; Kamanda, Allan; Ayuku, David; Nyandiko, Winstone; Atwoli, Lukoye; Ayaya, Samuel; Gisore, Peter; Scanlon, Michael; Braitstein, PaulaInvolving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers, community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent.Item Hand Grip Strength and Body Composition in HIV-Infected Rural Kenyan Women(2012-04-23) Ernst, Judith A.; Ettyang, Grace; Johnson, Cynthia; Nyandiko, Winstone; Siika, Abraham; Neumann, CharlotteTo determine if meat in the diets of HIV infected rural Kenyan women prevents the loss of strength and body mass in those not yet ill enough to warrant antiretroviral drugs.Item HIV Infection and Nutrition Status: The Importance of Food in Disease Management(Global Livestock CRSP, UC Davis, 2008-11) Ernst, Judith A.; Ettyang, Grace; Neumann, Charlotte; Nyandiko, Winstone; Siika, AbrahamPreliminary evidence suggests that improved nutrition early in human immunodeficiency virus (HIV) infection may delay progression to acquired immunodeficiency syndrome (AIDS) and delay the initiation or improve the effectiveness of antiretroviral drug therapy (ART). The scientific community has evolved in its appreciation of the value of food as an integral component of comprehensive care for individuals with HIV infection and AIDS. It is now well recognized that those who are food insecure and malnourished are more likely to fail drug treatment regimens. Body mass index (BMI) < 18 at the initiation of ART is strongly predictive of death. In addition, weight loss during the first four weeks of ART is also associated with death. A higher BMI is protective and is associated with better responses with ART. Patient response to nutrition intervention, however, may be confounded by the stage of HIV progression and other infections. That is, those who are in the earlier stages of the disease may respond better to aggressive nutrition intervention. The HIV Nutrition Project (HNP), "Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children," will evaluate the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, researchers will study if the inclusion of meat added as an ingredient to a biscuit, when compared to soy or wheat, will best protect the immune system and prevent severe infection, prevent the loss of body mass and enhance the quality of life. These women are not yet receiving antiretroviral drugs and therefore not yet experiencing metabolic inefficiencies associated with AIDS.Item Introduction to the HIV Nutrition Project (HNP): Increasing Animal Source Foods (ASF) in Diets of HIV-infected Kenyan Women and Their Children(Global Livestock CRSP, UC Davis, 2008-11) Ernst, Judith A.; Ettyang, Grace; Neumann, Charlotte; Nyandiko, Winstone; Siika, Abraham; Yiannoutsos, ConstantinMany of the 28 million people with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) estimated to be living in sub-Saharan Africa also suffer from malnutrition. Reproductive-aged women, their infants and young children are among the most vulnerable to malnutrition and progression of HIV to AIDS. As seen in eastern and southern Africa, mortality is increased in the malnourished. The HIV Nutrition Project (HNP) researchers will be evaluating the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, the study will determine if meat in the diets of HIV-infected women and their children (1) protects the immune system and prevents severe infection, (2) prevents the loss of lean body mass, enhancing the quality of life among these drug naive women and enabling women to carry out their activities of daily living, and (3) supports the growth and development of their vulnerable children when compared to those given supplements with the same amount of energy, but with either soya or wheat protein. The intervention food with beef protein provides significantly more vitamin B12, lysine and bio-available iron and zinc when compared to the soya and wheat supplements. Deficiencies of these nutrients may hasten HIV disease progression.Item Models of care for orphaned and separated children and upholding children’s rights: cross-sectional evidence from western Kenya(2014-04) Embleton, Lonnie; Ayuku, David; Kamanda, Allan; Atwoli, Lukoye; Ayaya, Samuel; Vreeman, Rachel; Nyandiko, Winstone; Gisore, Peter; Koech, Julius; Braitstein, PaulaBackground Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children’s basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. Methods The Orphaned and Separated Children’s Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher’s exact test was also used if some cells had expected value of less than 5. Results Included in this analysis are data from 300 households, 19 Charitable Children’s Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI’s and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as ‘Pure CCI’ for those only providing residential care, ‘CCI-Plus’ for those providing both residential care and community-based supports to orphaned children , and ‘CCI-Shelter’ which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p < 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17%) and institutions were better able to provide an adequate standard of living. Conclusions Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children.Item Morbidity and nutrition status of rural drug-naïve Kenyan women living with HIV(Taylor & Francis, 2016) Neumann, Charlotte G.; Nyandiko, Winstone; Siika, Abraham; Drorbaugh, Natalie; Samari, Goleen; Ettyang, Grace; Ernst, Judith A.; Department of Health Sciences, School of Health and Rehabilitation SciencesThis paper describes morbidity in a group of HIV-positive drug-naïve rural women in western Kenya. A total of 226 drug-naïve HIV-positive women were evaluated for baseline morbidity, immune function, and anthropometry before a food-based nutrition intervention. Kenyan nurses visited women in their homes and conducted semi-structured interviews regarding symptoms and physical signs experienced at the time of the visit and during the previous week and physical inspection. Blood and urine samples were examined for determination of immune function (CD4, CD8, and total lymphocyte counts), anaemia, malaria, and pregnancy status. Intradermal skin testing with tuberculin (PPD), candida, and tetanus toxoid antigens was also performed to evaluate cell-mediated immunity. Anthropometry was measured, and body mass index (BMI) was calculated. Seventy-six per cent of the women reported being sick on the day of the interview or within the previous week. Illnesses considered serious were reported by 13.7% of women. The most frequent morbidity episodes reported were upper respiratory tract infections (13.3%), suspected malaria (5.85%), skeletal pain (4.87%), and stomach pain (4.42%). The most common morbidity signs on physical inspection were respiratory symptoms, most commonly rhinorrhea and coughing. Confirmed malaria and severe diarrhea were significantly associated with a higher BMI.Item Perspectives of education sector stakeholders on a teacher training module to reduce HIV/AIDS stigma in Western Kenya(BMC, 2021-06-30) Chory, Ashley; Nyandiko, Winstone; Beigon, Whitney; Aluoch, Josephine; Ashimosi, Celestine; Munyoro, Dennis; Scanlon, Michael; Apondi, Edith; Vreeman, Rachel; Medicine, School of MedicineBackground: For adolescents living with HIV (ALWH), school may be the most important but understudied social sphere related to HIV stigma. Teachers are role models in the classroom and within the community, and their attitudes and behavior towards people living with HIV may have critical psychosocial and treatment ramifications. Altering teachers' knowledge, attitudes and beliefs (K/A/B) about HIV could reduce the stigmatizing content within their teaching, classrooms and school, improving the environment for ALWH. Methods: We developed a one-day teacher training module to enrich teacher K/A/B that included lecture presentations, HIV films and educational animation, structured instructions for teacher role play scenarios, and a question-and-answer session facilitated by a trained ALWH peer educator. We also conducted key informant interviews with education sector subject matter experts (SMEs), including education officers, county commissioners and head teachers to review and provide feedback on the teacher training module. Results: We assembled an adolescent community advisory board and recruited 50 SMEs to review the training module and provide feedback. All SME participants stressed the importance and need for interventions to reduce stigma in the classroom, highlighting their own experiences observing stigmatizing behaviors in the community. The participants perceived the training as culturally relevant and easy to understand and had minor suggestions for improvement, including using image-based resources and brighter colors for ease of reading. All participants thought that the training should be expanded outside of the schools, as all people in a community have a role in the reduction of HIV stigma, and offered suggestions for other settings for implementation. Conclusion: Data from interviews with education sector stakeholders demonstrate that our process for developing a culturally appropriate multi-media intervention to reduce HIV stigma in the schools was feasible.