Browsing by Subject "East Africa"

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    Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa
    (Plos, 2016-08-10) Rachlis, Beth; Bakoyannis, Giorgos; Easterbrook, Philippa; Genberg, Becky; Braithwaite, Scott; Cohen, Craig R.; Bukusi, Elizabeth A.; Kambugu, Andrew; Bwana, Mwebesa Bosco; Somi, Geoffrey R.; Geng, Elvin H.; Musick, Beverly; Yiannoutsos, Constantin T.; Wools-Kaloustian, Kara; Braitstein, Paula; Department of Biostatistics, Richard M. Fairbanks School of Public Health
    Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.
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    Feasibility of Rapid Case Ascertainment for Cancer in East Africa: An Investigation of Community-Representative Kaposi Sarcoma in the Era of Antiretroviral Therapy
    (Elsevier, 2021) Semeere, Aggrey; Byakwaga, Helen; Laker-Oketta, Miriam; Freeman, Esther; Busakhala, Naftali; Wenger, Megan; Kasozi, Charles; Ssemakadde, Matthew; Bwana, Mwebesa; Kanyesigye, Michael; Kadama-Makanga, Philippa; Rotich, Elyne; Kisuya, Job; Sang, Edwin; Maurer, Toby; Wools-Kaloustian, Kara; Kambugu, Andrew; Martin, Jeffrey; Medicine, School of Medicine
    Background: Rapid case ascertainment (RCA) refers to the expeditious and detailed examination of patients with a potentially rapidly fatal disease shortly after diagnosis. RCA is frequently performed in resource-rich settings to facilitate cancer research. Despite its utility, RCA is rarely implemented in resource-limited settings and has not been performed for malignancies. One cancer and context that would benefit from RCA in a resource-limited setting is HIV-related Kaposi sarcoma (KS) in sub-Saharan Africa. Methods: To determine the feasibility of RCA for KS, we searched for all potential newly diagnosed KS among HIV-infected adults attending three community-based facilities in Uganda and Kenya. Searching involved querying of electronic medical records, pathology record review, and notification by clinicians. Upon identification, a team verified eligibility and attempted to locate patients to perform RCA, which included epidemiologic, clinical and laboratory measurements. Results: We identified 593 patients with suspected new KS. Of the 593, 171 were ineligible, mainly because biopsy failed to confirm KS (65%) or KS was not new (30%). Among the 422 remaining, RCA was performed within 1 month for 56% of patients and within 3 months for 65% (95% confidence interval: 59 to 70%). Reasons for not performing RCA included intervening death (47%), inability to contact (44%), refusal/unsuitable to consent (8.3%), and patient re-location (0.7%). Conclusions: We found that RCA - an important tool for cancer research in resource-rich settings - is feasible for the investigation of community-representative KS in East Africa. Feasibility of RCA for KS suggests feasibility for other cancers in Africa.
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    Microfinance, retention in care, and mortality among patients enrolled in HIV 2 Care in East Africa
    (Wolters Kluwer, 2021-10) Genberg, Becky L.; Wilson-Barthes, Marta G.; Omodi, Victor; Hogan, Joseph W.; Steingrimsson, Jon; Wachira, Juddy; Pastakia, Sonak; Tran, Dan N.; Kiragu, Zana W.; Ruhl, Laura J.; Rosenberg, Molly; Kimaiyo, Sylvester; Galárraga, Omar; Medicine, School of Medicine
    Objective: To measure associations between participation in community-based microfinance groups, retention in HIV care, and death among people with HIV (PWH) in low-resource settings. Design and methods: We prospectively analyzed data from 3609 patients enrolled in an HIV care program in western Kenya. HIV patients who were eligible and chose to participate in a Group Integrated Savings for Health Empowerment (GISHE) microfinance group were matched 1 : 2 on age, sex, year of enrollment in HIV care, and location of initial HIV clinic visit to patients not participating in GISHE. Follow-up data were abstracted from medical records from January 2018 through February 2020. Logistic regression analysis examined associations between GISHE participation and two outcomes: retention in HIV care (i.e. >1 HIV care visit attended within 6 months prior to the end of follow-up) and death. Socioeconomic factors associated with HIV outcomes were included in adjusted models. Results: The study population was majority women (78.3%) with a median age of 37.4 years. Microfinance group participants were more likely to be retained in care relative to HIV patients not participating in a microfinance group [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) 1.01–1.71; P = 0.046]. Participation in group microfinance was associated with a reduced odds of death during the follow-up period (aOR = 0.57, 95% CI 0.28–1.09; P = 0.105). Conclusion: Participation in group-based microfinance appears to be associated with better HIV treatment outcomes. A randomized trial is needed to assess whether microfinance groups can improve clinical and socioeconomic outcomes among PWH in similar settings.
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    Serving East African Bioethics information and education needs
    (Medical Library Association, 2013-05-06) Odell, Jere D.; Allgood, Kacy; Kamaara, Eunice K.; McBride, Kalli; Ralston, Rick K.
    Objective: To identify the challenges of supporting the information needs of students and researchers participating in an international research ethics education practicum and exchange between universities in Kenya and the United States. Methods: One component of a grant-funded international research ethics training partnership supports a six-week intensive practicum exchange program. Master's level students from Moi University, Eldoret, Kenya, travel to the Indiana University (IU) School of Medicine-Indianapolis. While at the IU School of Medicine, the Kenyan students use library services to prepare for a mentored research project. As an outcome of the project, students are expected to conduct an extensive literature search that will be used as a foundational component for a thesis that is completed in Kenya. An informationist is embedded in this program to support the information needs of faculty mentors and practicum students. This paper uses narrative reports and program evaluation data to identify the challenges of (1) providing information literacy education, (2) confronting resource inequities, and (3) supporting information needs across cultures and universities in two countries. Results: Two cohorts of Kenyan students completed this practicum. The program leaders and librarians continue to adapt the information skills sessions to meet student interests and needs. Teaching has been a challenge because students demonstrate a wide range of technical sophistication. Some have extensive computing experience, but others struggle with Internet navigation, account authentication, and common technology skills. In the second cohort, the students worked well in pairs to find relevant research ethics materials while using the university's information portals and subscription resources. In both cohorts, students expressed a desire for a slower instruction pace and for additional sessions. Students were frequent customers for reference support. Librarians observed a preference for print monographs. While confirming a need for both print and electronic resources, practicum students have initiated a small and growing library of print materials for bioethics research at Moi University. Conclusion: Teaching information skills to a small group of adult students with a wide range of educational experiences is a challenge when students are working in a new (information rich) environment. Student evaluations have expressed an appreciation for instruction customized to their interests and needs, a slow delivery style, and opportunities for one-to-one instruction.