Browsing by Author "Were, Edwin"

Now showing 1 - 6 of 6
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    Implementing WHO Differentiated Service Delivery Model for Pregnant and Breastfeeding Women and Infants Living with HIV: Insights from Kenyan Healthcare Providers
    (Global Health and Education Projects, 2025-01-22) Humphrey, John; Carlucci, James G.; Wanjama, Esther Karen; Naanyu, Violet; Muli, Lindah; Alera, Joy Marsha; Were, Edwin; McGuire, Alan; Nyandiko, Winstone; Zimet, Gregory; Jerono Songok, Julia; Wools-Kaloustian, Kara; Medicine, School of Medicine
    Background and Objective:: Differentiated service delivery (DSD) is a strategy endorsed by the World Health Organization that simplifies and adapts human immunodeficiency (HIV) services to meet the needs of people living with HIV (PLHIV) while reducing unnecessary health system burdens. DSD for PLHIV has been widely adopted in sub-Saharan Africa, but DSD for women and infants enrolled in prevention of mother-to-child HIV transmission (PMTCT) services is lacking. Methods:: We conducted in-depth interviews with healthcare providers (i.e., clinicians, nurses, and mentor mothers) in antenatal and postnatal clinics at two facilities affiliated with the Academic Model Providing Access to Healthcare (AMPATH) in Kenya to explore perspectives on the adaptation of DSD for PMTCT. Providers were recruited in person at each facility. Interview guides focused on their views on DSD implementation for PMTCT, characteristics of stable and unstable PMTCT clients, and strategies to improve PMTCT services. We used inductive coding with illustrative quotes to highlight emerging themes. Results:: 12 PMTCT providers (6 antenatal, 6 postnatal; 4 clinicians, 4 nurses, and 4 mentor mothers) were enrolled; 10 (83%) were female, with a median age of 40 years, and a median of 7 years of PMTCT experience. Providers held positive views about the potential benefits of DSD for PMTCT but expressed concern about reducing service intensity during pregnancy/breastfeeding. Providers also suggested specific criteria defining stable PMTCT clients beyond those used for non-pregnant PLHIV, such as having no pregnancy complications, psychosocial or socioeconomic barriers, or breastfed infants. Conclusion and Global Health Implications:: Filling the gap in DSD guidance for this population will require adaptations to the DSD model that are responsive to providers’ concerns and the unique aspects of the pregnancy-postpartum service continuum, which may vary across settings based on contextual and client-level factors. Such nuanced guidance will need to remain clear and simple to implement to ensure implementation fidelity at scale.
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    Integrating Prevention of Mother-to-Child Transmission of HIV Care into General Maternal Child Health Care in Western Kenya
    (Global Health and Education Projects, 2021) Berlacher, Michelle; Mercer, Timothy; Apondi, Edith O.; Mwangi, Winfred; Were, Edwin; McHenry, Megan S.; Medicine, School of Medicine
    Background: Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework. Methods: A framework adapted from the World Health Organization's six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and challenges of integration across each of the health system functions were evaluated to better understand this approach. Results: Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits and challenges of integration. Benefits of integration included convenience for families through streamlining of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV status, particularly in the context of high-volume, crowded clinical spaces. Conclusion and global health implications: The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system.
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    Perceived benefits and barriers to the use of long-acting injectable antiretroviral treatment among adolescents and young people living with HIV in Western Kenya: qualitative findings from the KuwaFree! LiveFree! Study
    (Frontiers Media, 2025-03-07) Hassan, Shukri A.; Munyoro, Dennis; Maju, Mehar; Biegon, Whitney; Bakari, Salim; Kaguiri, Eunice; Jumah, Anjellah; Omollo, Mark; Obare, Valerie; Bernard, Caitlin; Apondi, Edith; Were, Edwin; Patel, Rena C.; Obstetrics and Gynecology, School of Medicine
    Introduction: Adolescents and young people living with HIV (AYPLHIV) face significant hurdles in adhering to daily oral antiretroviral therapy (ART). Long-acting (LA) ART, such as injectable cabotegravir and rilpivirine, may help overcome these hurdles. However, little is known about the perceived benefits and barriers to LA ART usage by AYPLHIV in resource-limited settings. Methods: We conducted focus group discussions (FGDs) with four target groups of adolescents/youth, providers, policymakers, and other advocates in western Kenya from November 2021 to April 2022. The FGDs elicited participants' thoughts on LA ART implementation in Kenya, particularly the benefits and barriers of LA ART use amongst AYPLHIV. Our analysis combined both inductive and deductive approaches, beginning with open coding of the data, then organizing them in predetermined socio-ecological model (SEM) domains. Results and discussion: We conducted a total of seven FGDs with 58 participants across four stakeholder groups: AYPLHIV (2 FGDs, n = 14), healthcare providers (2 FGDs, n = 19), health/youth advocates (2 FGDs, n = 16), and policymakers (1 FGD, n = 9). We identified several benefits, largely centered around the individual and interpersonal level, as well as barriers, largely centered around the health systems levels. Participants viewed LA ART as a welcome alternative to oral ART due to benefits like improved adherence, reduced pill burden, increased convenience, enhanced privacy, decreased stigma, lower risk of accidental disclosure, and convergence in using LA contraception. At the interpersonal level, LA ART was valued for furthering relationships, especially for AYPLHIV (e.g., dating). At the health systems level, LA ART expanded first-line treatment options. Conversely, barriers to health systems integration included conflicts with service models, increased clinic burden, supply chain issues, and waste disposal. Individual-level barriers included fears of injections, side effects, concerns about a new drug, and reduced effectiveness if mixing LA ART with oral ART. Conclusions: The perceived benefits of LA ART for AYPLHIV, centering on individual and interpersonal levels of positive impacts, appear in tension with the anticipated barriers for health systems readiness in Kenya. While the prospect of offering LA ART is overwhelming positive, country programs will have to invest in health systems readiness before rolling out LA ART.
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    Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya: protocol for a prospective cohort study (Tabiri Study)
    (BMJ, 2022-04-04) Oyungu, Eren; El Kebbi, Ola; Vreeman, Rachel; Nyandiko, Winstone; Monahan, Patrick O.; Tu, Wanzhu; Khaitan, Alka; Desta, Zeruesenay; Slogrove, Amy L.; Humphrey, John M.; Were, Edwin; Patel, Rena C.; Carlucci, James G.; Wools-Kaloustian, Kara; McHenry, Megan S.; Pediatrics, School of Medicine
    Introduction: For the growing number of children with in utero and postpartum exposure to HIV and/or antiretrovirals, it is unclear which exposures or risk factors play a significant role in predicting worse neurodevelopmental outcomes. This protocol describes a prospective longitudinal cohort study of infants born to mothers living with HIV and those born to mothers without HIV. We will determine which risk factors are most predictive of child neurodevelopment at 24 months. We aim to create a risk assessment tool to help predict which children are at risk for worse neurodevelopment outcomes. Methods and analysis: This study leverages an existing Kenyan cohort to prospectively enrol 500 children born to mothers living with HIV and 500 to those without HIV (n=1000 total) and follow them from birth to age 24 months. The following factors will be measured every 6 months: infectious morbidity and biological/sociodemographic/psychosocial risk factors. We will compare these factors between the two groups. We will then measure and compare neurodevelopment within children in both groups at 24 months of age using the Child Behaviour Checklist and the Bayley Scales of Infant and Toddler Development, third edition. Finally, we will use generalised linear mixed modelling to quantify associations with neurodevelopment and create a risk assessment tool for children ≤24 months. Ethics and dissemination: The study is approved by the Moi University's Institutional Research and Ethics Committee (IREC/2021/55; Approval #0003892), Kenya's National Commission for Science, Technology and Innovation (NACOSTI, Reference #700244) and Indiana University's Institutional Review Board (IRB Protocol #110990). This study carries minimal risk to the children and their mothers, and all mothers will provide written consent for participation in the study. Results will be disseminated to maternal child health clinics within Uasin Gishu County, Kenya and via papers submitted to peer-reviewed journals and presentation at international conferences.
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    Preferences of Pregnant and Postpartum Women for Differentiated Service Delivery in Kenya
    (Wolters Kluwer, 2023) Humphrey, John; Wanjama, Esther; Carlucci, James G.; Naanyu, Violet; Were, Edwin; Muli, Lindah; Alera, Marsha; McGuire, Alan; Nyandiko, Winstone; Songok, Julia; Wools-Kaloustian, Kara; Zimet, Gregory; Medicine, School of Medicine
    Background: Differentiated service delivery models are implemented by HIV care programs globally, but models for pregnant and postpartum women living with HIV (PPWH) are lacking. We conducted a discrete choice experiment to determine women's preferences for differentiated service delivery. Setting: Five public health facilities in western Kenya. Methods: PPWH were enrolled from April to December 2022 and asked to choose between pairs of hypothetical clinics that differed across 5 attributes: clinic visit frequency during pregnancy (monthly vs. every 2 months), postpartum visit frequency (monthly vs. only with routine infant immunizations), seeing a mentor mother (each visit vs. as needed), seeing a clinician (each visit vs. as needed), and basic consultation cost (0, 50, or 100 Kenya Shillings [KSh]). We used multinomial logit modeling to determine the relative effects (β) of each attribute on clinic choice. Results: Among 250 PPWH (median age 31 years, 42% pregnant, 58% postpartum, 20% with a gap in care), preferences were for pregnancy visits every 2 months (β = 0.15), postpartum visits with infant immunizations (β = 0.36), seeing a mentor mother and clinician each visit (β = 0.05 and 0.08, respectively), and 0 KSh cost (β = 0.39). Preferences were similar when stratified by age, pregnancy, and retention status. At the same cost, predicted market choice for a clinic model with fewer pregnant/postpartum visits was 75% versus 25% for the standard of care (ie, monthly visits during pregnancy/postpartum). Conclusion: PPWH prefer fewer clinic visits than currently provided within the standard of care in Kenya, supporting the need for implementation of differentiated service delivery for this population.
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    Understanding Women’s Preferences for Prevention of Mother-to- Child HIV Transmission Services in Kenya
    (Global Health and Education Projects, 2024-05-17) Humphrey, John; Wanjama, Esther; Carlucci, James G.; Naanyu, Violet; Muli, Lindah; Were, Edwin; McGuire, Alan; Nyandiko, Winstone M.; Songok, Julia; Zimet, Gregory; Wools-Kaloustian, Kara; Medicine, School of Medicine
    Background and objective: Understanding the preferences of women living with HIV (WLH) for the prevention of mother-to-child HIV transmission (PMTCT) services is important to ensure such services are person-centered. Methods: From April to December 2022, we surveyed pregnant and postpartum WLH enrolled at five health facilities in western Kenya to understand their preferences for PMTCT services. WLH were stratified based on the timing of HIV diagnosis: known HIV-positive (KHP; before antenatal clinic [ANC] enrollment), newly HIV-positive (NHP; on/after ANC enrollment). Multivariable logistic regression was used to determine associations between various service preferences and NHP (vs. KHP) status, controlling for age, facility, gravidity, retention status, and pregnancy status. Results: Among 250 participants (median age 31 years, 31% NHP, 69% KHP), 93% preferred integrated versus non-integrated HIV and maternal-child health (MCH) services; 37% preferred male partners attend at least one ANC appointment (vs. no attendance/no preference); 54% preferred support groups (vs. no groups; 96% preferred facility - over community-based groups); and, preferences for groups was lower among NHP (42%) versus KHP (60%). NHP had lower odds of preferring support groups versus KHP (aOR 0.45, 95% CI 0.25-0.82), but not the other services. Conclusion and global health implications: Integrated services were highly preferred by WLH, supporting the current PMTCT service model in Kenya. Further research is needed to explore the implementation of facility-based support groups for WLH as well as the reasons underlying women's preferences.