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Embleton L, Shah P, Apondi E, Ayuku D, Braitstein P. "If they had a place to live, they would be taking medication": a qualitative study identifying strategies for engaging street-connected young people in the HIV prevention-care continuum in Kenya. J Int AIDS Soc 2023; 26:e26023. [PMID: 37267115 PMCID: PMC10237327 DOI: 10.1002/jia2.26023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/15/2022] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Street-connected young people (SCY) experience structural and social barriers to engaging in the HIV prevention-care continuum. We sought to elicit recommendations for interventions that may improve SCY's engagement along the HIV prevention-care continuum from healthcare providers, policymakers, community members and SCY in Kenya. METHODS This qualitative study was conducted in Uasin Gishu, Trans Nzoia, Bungoma, Nakuru and Kitale counties in Kenya between May 2017 and September 2018 to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY. This secondary analysis focuses on a subset of data interviews that investigated SCY's healthcare needs in relation to HIV prevention and care. We conducted 41 in-depth interviews and seven focus group discussions with 100 participants, of which 43 were SCY. In total, 48 participants were women and 52 men. RESULTS Our analysis resulted in four major themes corresponding to stages in the HIV prevention-care continuum for key populations. We identified the need for an array of strategies to engage SCY in HIV prevention and testing services that are patient-centred and responsive to the diversity of their circumstances. The use of pre-exposure prophylaxis was a biomedical prevention strategy that SCY and healthcare providers alike stressed the need to raise awareness around and access to for SCY. Several healthcare providers suggested peer-based approaches for engaging SCY throughout the continuum. However, SCY heavily debated the appropriateness of using peer-based methods. Structural interventions, such as the provision of food and housing, were suggested as strategies to improve antiretroviral therapy adherence. CONCLUSIONS This study identified contextually relevant interventions that should be adapted and piloted for use with SCY. Education and sensitization of SCY and healthcare providers alike were identified as possible strategies, along with affordable housing and anti-poverty strategies as cash transfers and provision of food. Peer-based interventions are a clear option but require SCY-specific adaptation to be implemented effectively.
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Affiliation(s)
- Lonnie Embleton
- Centre for Global HealthDalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Pooja Shah
- London School of Hygiene & Tropical MedicineLondonUK
| | | | - David Ayuku
- Department of Mental Health and Behavioural ScienceCollege of Health SciencesMoi UniversityEldoretKenya
| | - Paula Braitstein
- Department of EpidemiologyDalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- School of Public Health, College of Health SciencesMoi UniversityEldoretKenya
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Ransing R, de la Rosa PA, Pereira-Sanchez V, Handuleh JIM, Jerotic S, Gupta AK, Karaliuniene R, de Filippis R, Peyron E, Sönmez Güngör E, Boujraf S, Yee A, Vahdani B, Shoib S, Stowe MJ, Jaguga F, Dannatt L, da Silva AK, Grandinetti P, Jatchavala C. Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2022. [PMID: 34735077 DOI: 10.4762/2237-6089-2021-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. METHODS PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. RESULTS The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). CONCLUSIONS Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Maharashtra, India
| | - Pedro A de la Rosa
- Educación de la Afectividad y Sexualidad Humana, Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Spain. Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Victor Pereira-Sanchez
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Stefan Jerotic
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Ruta Karaliuniene
- Elblandklinikum Radebeul Clinic for Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | | | - Ekin Sönmez Güngör
- Department of Psychiatry, University of Health Sciences, Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Said Boujraf
- Clinical Neurosciences Laboratory, Sidi Mohamed ben Abdellah University, Fez, Morocco
| | - Anne Yee
- Department of Psychological Medicine, University Malaya Centre of Addiction Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bita Vahdani
- Qazvin University of Medical Sciences Qazvin, Iran. Department of Psychology, University of Tehran, Tehran, Iran
| | - Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Rainawari, Kashmir, India
| | - M J Stowe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Paolo Grandinetti
- Addictions Service, Department of Territorial Services, ASL Teramo, Teramo, Italy
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Fernandes Silva E, de Oliveira VMC, Monteiro CFDS, da Silva A, Carvalho MSM, Magalhães RDLB. Tracking the pattern of alcohol consumption among homeless people. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2064347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | - Alice da Silva
- Nursing Department, Federal University of Piauí, Teresina, Brazil
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Embleton L, Di Ruggiero E, Logie CH, Ayuku D, Braitstein P. Improving livelihoods and gender equitable attitudes of street-connected young people in Eldoret, Kenya: Results from a pilot evidence-based intervention. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:227-240. [PMID: 32633059 DOI: 10.1111/hsc.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
Street-connected young people (SCY) in Eldoret, Kenya, experience substantial gender inequities, economic marginalization and are highly vulnerable to acquiring HIV. This study sought to explain and explore how participation in a pilot-adapted evidence-based intervention, Stepping Stones and Creating Futures, integrated with matched savings, changed SCY's economic resources, livelihoods and gender equitable attitudes. We piloted our adapted intervention using a convergent mixed-methods design measuring outcomes pre- and post-intervention with 80 SCY in four age- and gender-stratified groups of 20 participants per group (young women aged 16-19 years and 20-24 years, young men aged 16-19 years and 20-24 years). The pilot occurred at MTRH-Rafiki Centre for Excellence in Adolescent Health in Eldoret, Kenya, from September 2017 to January 2018. Through street outreach, Peer Facilitators created four age- and gender-stratified sampling lists of SCY whom met the eligibility criteria and whom indicated their interest in participating in the intervention during outreach sessions. Simple random sampling was used to select eligible participants who indicated their interest in participating in the intervention. The adapted intervention, Stepping Stones ya Mshefa na Kujijenga Kimaisha, included 24 sessions that occurred over 14 weeks, focused on sexual and reproductive health, gender norms in society, livelihoods and included a matched-savings programme conditional on attendance. The primary outcome of interest was gender equitable attitudes measured using the Gender Equitable Men scale and secondary outcomes included economic resources and livelihoods. Participants had a significant change in gender equitable attitudes from pre- to post-intervention from 43 (IQR 38-48) to 47 (IQR 42-51) (p < .001). Quantitatively and qualitatively participants reported increases in daily earnings, changes in street involvement, housing and livelihood activities. Overall, this study demonstrated that the adapted programme might be effective at changing gender equitable attitudes and improving livelihood circumstances for SCY in Kenya.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - David Ayuku
- Department of Behavioural Science, College of Health Science, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Embleton L, Shah P, Amin Gayapersad A, Kiptui R, Ayuku D, Braitstein P. Identifying Strategies to Advance Health Equity through Action on Social Determinants of Health and Human Rights for Street-Connected Children and Youth in Kenya. Health Hum Rights 2020; 22:177-197. [PMID: 33390706 PMCID: PMC7762894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite the fact that street-connected children and youth (SCY) in low- and middle-income countries experience numerous social and health inequities, few evidence-based policies and interventions have been implemented to improve their circumstances. Our study analyzed strategies to advance health equity through action on the social determinants of health (SDH) for SCY in Kenya based on General Comment 21 of the United Nations Committee on the Rights of the Child. To identify policies and interventions, we analyzed archival newspaper articles and policy documents and elicited ideas from a diversity of social actors across Kenya. Our results identified three types of policies and interventions: repressive, welfare oriented, and child rights based. We then situated these strategies within the World Health Organization's conceptual framework on SDH inequities to understand their mechanism of impact on health equity. Our results demonstrate that a child rights approach provides a strong avenue for advancing health equity through action on the SDH for SCY in Kenya. As a result of these findings, we developed a checklist for policy makers and other stakeholders to assess how their policies and interventions are upholding human rights, addressing needs, and working to advance health equity for SCY.
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Affiliation(s)
- Lonnie Embleton
- Postdoctoral fellow at the Dalla Lana School of Public Health at the University of Toronto, Canada
| | - Pooja Shah
- PhD student in the Faculty of Public Health and Policy at the London School of Hygiene and Tropical Medicine, United Kingdom
| | - Allison Amin Gayapersad
- Postdoctoral fellow at the Dalla Lana School of Public Health at the University of Toronto, Canada
| | - Reuben Kiptui
- Research Coordinator at the Academic Model Providing Access to Healthcare in Eldoret, Kenya
| | - David Ayuku
- Professor of Clinical Psychology at the Moi University School of Medicine, Eldoret, Kenya
| | - Paula Braitstein
- Epidemiologist and Associate Professor at the Dalla Lana School of Public Health at the University of Toronto, Canada
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Embleton L, Shah P, Gayapersad A, Kiptui R, Ayuku D, Braitstein P. Characterizing street-connected children and youths' social and health inequities in Kenya: a qualitative study. Int J Equity Health 2020; 19:147. [PMID: 32859193 PMCID: PMC7455900 DOI: 10.1186/s12939-020-01255-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Street-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality. We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Therefore, we sought to identify and understand how SCY's social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17. METHODS This qualitative study was conducted from May 2017 to September 2018 using multiple methods including focus group discussions, in-depth interviews, archival review of newspaper articles, and analysis of a government policy document. We purposively sampled 100 participants including community leaders, government officials, vendors, police officers, general community residents, parents of SCY, and stakeholders in 5 counties across Kenya to participate in focus group discussions and in-depth interviews. We conducted a thematic analysis situated in the conceptual framework on SDH and the CRC. RESULTS Our findings indicate that SCY's social and health disparities arise as a result of structural and social determinants stemming from a socioeconomic and political environment that produces systemic discrimination, breaches human rights, and influences their unequal socioeconomic position in society. These social determinants influence SCY's intermediary determinants of health resulting in a lack of basic material needs, being precariously housed or homeless, engaging in substance use and misuse, and experiencing several psychosocial stressors, all of which shape health outcomes and equity for this population. CONCLUSIONS SCY in Kenya experience social and health inequities that are avoidable and unjust. These social and health disparities arise as a result of structural and social determinants of health inequities stemming from the socioeconomic and political context in Kenya that produces systemic discrimination and influences SCYs' unequal socioeconomic position in society. Remedial action to reverse human rights contraventions and to advance health equity through action on SDH for SCY in Kenya is urgently needed.
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Affiliation(s)
- L Embleton
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada
| | - P Shah
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - A Gayapersad
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
| | - R Kiptui
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - D Ayuku
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
- Department of Behavioural Science, School of Medicine, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - P Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada.
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada.
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya.
- Department of Medicine, School of Medicine, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya.
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Factors influencing access of HIV and sexual and reproductive health services among adolescent key populations in Kenya. Int J Public Health 2020; 65:425-432. [PMID: 32337631 PMCID: PMC7275021 DOI: 10.1007/s00038-020-01373-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/03/2020] [Accepted: 03/12/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The objective of this study is to identify enablers and barriers in access of HIV and sexual reproductive health (SRH) services among adolescent key populations (KP) in Kenya. METHODS A cross-sectional study using qualitative methods was conducted between October 2015 and April 2016. A total of 9 focus group discussions and 18 in-depth interviews were conducted with 108 adolescent KPs in Mombasa, Kisumu and Nairobi Counties of Kenya. Data were recorded digitally, translated, transcribed and coded in NVivo10 prior to analysis. RESULTS Adolescent KPs preferred to access services in private health due to increased confidentiality, limited stigma and discrimination, access to adequate amount of condoms, friendly and fast-tracked services. Negative health provider attitudes made adolescent KPs dislike accessing health care in public health facilities. There was a lack of adolescent key population's policies and guidelines on HIV and SRH. CONCLUSIONS The study has demonstrated existing enablers and barriers to provision of HIV/SRH services for an at-risk population for which limited data exist. The results provide a basis for program redesign involving the adolescent KPs to minimize barriers for access to HIV/SRH services.
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Embleton L, Di Ruggiero E, Odep Okal E, Chan AK, Logie CH, Ayuku D, Braitstein P. Adapting an evidence-based gender, livelihoods, and HIV prevention intervention with street-connected young people in Eldoret, Kenya. Glob Public Health 2019; 14:1703-1717. [PMID: 31162989 PMCID: PMC6906550 DOI: 10.1080/17441692.2019.1625940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
Despite being highly vulnerable to acquiring HIV, no effective evidence-based interventions (EBI) exist for street-connected young people (SCY) in low- and middle-income countries (LMICs). Therefore, this paper describes the research process of adapting an existing EBI in Eldoret, Kenya using a modified ADAPT-ITT model with a young key population. From May to August 2018 we adapted the combined Stepping Stones and Creating Futures interventions. We used community-based participatory methods, focus group discussions, and working groups with four Peer Facilitators and 24 SCY aged 16-24 years. At the inception of this project, a matched-savings programme was integrated into the intervention to further address structural drivers of HIV. Numerous adaptations came forth through the participatory process. Engaging SCY in the adaptation process ensured the programme was responsive to their needs, relevant to the street context, and respected their right to participate in the research process.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, Faculty of Medicine, University of Toronto , Toronto , Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Evans Odep Okal
- Academic Model Providing Access to Healthcare , Eldoret , Kenya
| | - Adrienne K Chan
- Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
- Dignitas International , Zomba , Malawi
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto , Canada
| | - David Ayuku
- Department of Behavioural Science, College of Health Science, Moi University , Eldoret , Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
- Academic Model Providing Access to Healthcare , Eldoret , Kenya
- College of Health Sciences, School of Medicine, Moi University , Eldoret , Kenya
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Shah P, Kibel M, Ayuku D, Lobun R, Ayieko J, Keter A, Kamanda A, Makori D, Khaemba C, Ngeresa A, Embleton L, MacDonald K, Apondi E, Braitstein P. A Pilot Study of "Peer Navigators" to Promote Uptake of HIV Testing, Care and Treatment Among Street-Connected Children and Youth in Eldoret, Kenya. AIDS Behav 2019; 23:908-919. [PMID: 30269232 PMCID: PMC6458975 DOI: 10.1007/s10461-018-2276-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research suggests a burden of HIV among street-connected youth (SCY) in Kenya. We piloted the use of peer navigators (PNs), individuals of mixed HIV serostatus and with direct experience of being street-connected, to link SCY to HIV testing and care. From January 2015 to October 2017, PNs engaged 781 SCY (585 male, 196 female), median age 16 (IQR 13-20). At initial encounter, 52 (6.6%) were known HIV-positive and 647 (88.8%) agreed to HIV testing. Overall, 63/781 (8.1%) SCY engaged in this program were HIV-positive; 4.6% males and 18.4% females (p < 0.001). Of those HIV-positive, 48 (82.8%) initiated ART. As of October 2017, 35 (60.3%) of the HIV-positive SCY were alive and in care. The pilot suggests that PNs were successful in promoting HIV testing, linkage to care and ART initiation. More research is needed to evaluate how to improve ART adherence, viral suppression and retention in care in this population.
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Affiliation(s)
- Pooja Shah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Mia Kibel
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
| | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Regina Lobun
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - John Ayieko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Alfred Keter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Collins Khaemba
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Anthony Ngeresa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Lonnie Embleton
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Katherine MacDonald
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, USA
| | - Edith Apondi
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada.
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
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Kibel M, Shah P, Ayuku D, Makori D, Kamaara E, Choge E, Nyairo J, Abuya P, Wahome M, Wachira J, Braitstein P. Acceptability of a Pilot Intervention of Voluntary Medical Male Circumcision and HIV Education for Street-Connected Youth in Western Kenya. J Adolesc Health 2019; 64:43-48. [PMID: 30327277 DOI: 10.1016/j.jadohealth.2018.07.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Street-connected youth (SCY) in Kenya and elsewhere in sub-Saharan Africa are at high risk of HIV. Voluntary Male Medical Circumcision (VMMC) reduces the risk of female-to-male HIV transmission. Circumcision is also a traditional coming-of-age process in many Kenyan ethnic groups. This paper describes the acceptability of VMMC delivered as part of a ten-day healing, educational, and 'coming-of-age' retreat implemented as a pilot with SCY. METHODS Male SCY aged between 12 and 24 living on the street for more than 3 months were eligible to participate. The study took place over 10 days. After medical circumcision, youth participated in education modules. Data collected included qualitative semi-structured exit interviews featuring structured and open-ended questions about factors relevant to this intervention's acceptability. RESULTS There were 116 SCY (median age 14, IQR 13-15) who participated in the study. All were circumcised successfully, with no major complications. The majority of participants (81%) agreed that the circumcision procedure was uncomplicated, and 99% agreed the education was an important part of the initiation process. Thematic analysis of interview data highlighted four factors important to the program's acceptability: providing food, shelter, security; providing a safe place to heal; including traditional elements; and being with peers. CONCLUSIONS This novel implementation of VMMC was found to be acceptable to SCY participants and could likely be adapted and scaled for HIV prevention and education with SCY elsewhere in Kenya and sub-Saharan Africa where circumcision is part of traditional coming-of-age processes.
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Affiliation(s)
- Mia Kibel
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pooja Shah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - David Ayuku
- Department of Behavioural Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Eunice Kamaara
- Department of Philosophy and Religious Studies, School of Arts and Social Sciences, Moi University, Eldoret, Kenya; African Christian Initiation Program, Eldoret, Kenya
| | - Emily Choge
- Department of Philosophy and Religious Studies, School of Arts and Social Sciences, Moi University, Eldoret, Kenya; African Christian Initiation Program, Eldoret, Kenya
| | - Joyce Nyairo
- African Christian Initiation Program, Eldoret, Kenya
| | - Pamela Abuya
- African Christian Initiation Program, Eldoret, Kenya
| | - Mary Wahome
- Department of Philosophy and Religious Studies, School of Arts and Social Sciences, Moi University, Eldoret, Kenya; African Christian Initiation Program, Eldoret, Kenya
| | - Juddy Wachira
- Department of Behavioural Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
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Embleton L, Ayuku D, Makori D, Kamanda A, Braitstein P. Causes of death among street-connected children and youth in Eldoret, Kenya. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:19. [PMID: 29764412 PMCID: PMC5952842 DOI: 10.1186/s12914-018-0160-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/07/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Street-connected young people carry a disproportionate burden of morbidities, and engage in a variety of practices that may heighten their risk of premature mortality, yet there are currently no reports in the literature on the rates or risk factors for mortality among them, nor on their causes of death. In low- and middle-income countries they are frequently in situations that violate their human rights, likely contributing to their increased burden of morbidities and vulnerability to mortality. We thus sought to describe the number of deaths annually, causes of death, and determine the number of deaths attributable to HIV among street-connected young people aged 0 to 30 years in Eldoret, Kenya. METHODS Eldoret, Kenya has approximately 1900 street-connected young people. We collected data on deaths occurring from October 2009 to December 2016 from Moi Teaching and Referral Hospital records, Academic Model Providing Access to Healthcare HIV program records, and utilized verbal autopsies when no records were available. Descriptive analyses were conducted stratified by sex and age category, and frequencies and proportions were calculated to provide an overview of the decedents. We used logistic regression to assess the association between underlying cause of death and sex, while controlling for age and location of death. RESULTS In total there were 100-recorded deaths, 66 among males and 34 among females; 37% of were among those aged ≤18 years. HIV/AIDS (37%) was the most common underlying cause of death, followed by assault (36%) and accidents (10%) for all decedents. Among males, the majority of deaths were attributable to assault (49%) and HIV/AIDS (26%), while females primarily died due to HIV/AIDS (59%). CONCLUSION Our results demonstrate a high number of deaths due to assault among males and HIV/AIDS among males and females. Our findings demonstrate the need for studies of HIV prevalence and incidence among this population to characterize the burden of HIV, particularly among young women given the higher number of deaths attributed to HIV/AIDS among them. Most deaths were preventable and require the urgent attention of service providers and policymakers to implement programs and services to prevent premature mortality and uphold children's rights.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - David Ayuku
- College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | | | | | - Paula Braitstein
- College of Health Sciences, School of Medicine, Department of Medicine, Moi University, Eldoret, Kenya. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Regenstrief Institute Inc., Indianapolis, USA. .,Fairbanks School of Public Health, Indiana University, Indianapolis, USA. .,Division of Epidemiology, 155 College Street, Toronto, ON, M5T 3M, Canada.
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